T H E U NI V E R S IT Y O F M I C H I G A N SCHOOL OF DENTISTRY Final Report A CLINICAL EVALUATION OF ZINC OXIDE-EUGENOL CEMENTS Project Director. George Eo Myers, D.oDSo, M.oSog FoDoS.g F.AoCoD. Professor of Dentistry Chairman, Crown and Bridge Department Co-Principal Investigator~ Thomas D. Gi1son, D oDoSo, MoSo Research Associate, Crown and Bridge Department ORA Project 07622 under contract with~ Lo D. CAULK COMPANY MILFORD, DELAWARE administered throughO OFFICE OF RESEARCH ADMINISTRATION ANT ARBOR May 1967

TABLE OF CONTENTS Page LIST OF TABLES iv LIST OF FIGURES vi LIST OF GRAPHS vii INTRODUCTION 1 I. PRELIMINARY LABORATORY INVESTIGATION 2 A. Materials 2 B. Methods 2 C. Results 3 II. TEMPORARY CEMENTATION OF TEMPORARY RESTORATIONS 4 A. Materials 4 B. Methods 4 C. Results 5 D. Discussion 6 E. Conclusions 7 III. TEMPORARY CEMENTATION OF FINISHED RESTORATIONS 9 A. Materials 9 B. Methods 9 C. Results 11 D. Discussion 12 E. Conclusions 13 IV. FINAL CEMENTATION C FINISHED RESTORATIONS 14 A. Materials 14 B. Methods 14 C. Results 16 D. Discussion 18 E. Conclusions APPENDIX 49 METHODS OF DATA COLLECTION 49 DIRECTIONS FOR DATA SHEET 8/65 54 EXAMPLES OF DATA SHEET 8/65 FOR FINISHED RESTORATIONS 57 IBM FORMAT 60 iii

LIST OF TABLES Table Page I. Cements in Laboratory Study 21 II. Dropper Calibration 22 III. Laboratory Mixes 23 IV. Film Thickness, Cement F 24 V. Cements Selected for the Clinical Studies 25 VI. Acrylic Temporary Restorations 26 VII. Aluminum Temporary Restorations 27 VIII. Data at Removal Acrylic Temporary Restorations 28 IX. Data at Removal Aluminum Temporary Restorations 29 X. Completed Temporary Cementations of Finished Restorations, Successes and Failures 30 XI. Completed Temporary Cementations of Finished Restorations, Analysis of Successes and Failures 31 XII. Completed Temporary Cementations of Finished Restorations, Analysis of Failures 33 XIII. Completed Temporary Cementations of Finished Restorations, Data at Removal of Successes 34 XIV. Temporary Cementations of Finished Restorations Still in Place 35 XV. Temporary Cementations of Finished Restorations, Analysis of Bridges by Type of Fixation 36 XVI. Final Cementations of Finished Restorations Listed by Number of Units in Ascending Order; Cements D-5400, F-8000, and F-9200 37 iv

LIST OF TABLES (Concluded) Table Page XVII. Final Cementations of Finished Restorations Listed by Number of Retainers in Ascending Order; Cements D-5400, F-8000, and F-9200 38 XVIII. Number of Spans in Each Bridge 39 XIX. Number of Pontics in Longest Span of Bridge 39 XX. Type of Fixation 39 XXI. Retention Grades 40 XXII. Arch Location 40 XXIII. Occlusal Function Grade 41 XXIV. Student/Patient Reaction 41 XXV. Analysis of the Nine Bridges Which Came Loose 42 XXVI. Examinations of Successes 43 XXVII. Number of Restorations and Retainers Examined at Varying Time Intervals 44

LIST OF FIGURES Figure Page 1l Direction.s to students, cements C-2200 and E-3500. 68 2c Data sheet, temporary restorations. 69 3o Work sheet, temporary restorat. ons 70 4L Directions to students, temporary and final cementations of res torat_.. o 71 5o Data sheet for temporary and final cementationso 72 vi

LIST OF GRAPHS Graph Page I, Retention of all temporary restorations. 45 II. Retention of acrylic temporary restorations. 46 III. Retention of aluminum crowns. 47 IV. Taste —Burn or no burn. 48 vii

INTRODUCTION A progress report was made in August, 1965, of a preliminary study of the clinical behavior of five reinforced zinc oxide-eugenol cements of various crushing strengths. The study was of a double-blind nature. Two cements -were of the paste type with compression strengths of 200 psi and 1,000 psi. Three cements were of the powder and liquid type with compressive strengths of 2200 psi, 3500 psi and 5400 psi. Two of the cements (2200 psi and 3500 psi) proved to be satisfactory for temporary cementation of temporary restorations. Although some differences appeared to exist between these two cements, the data was not adequate in volume for a statistical analysis and it was recommended that further data be collected to determine any clinical differences in regard to taste and retention. The preliminary data collected in relation to cements 200 psi and 1,000 psi indicated that these cements might be adequate for the temporary cementation of finished restorations and it was recommended that data be collected to evaluate the use of these cements in this procedure. An analysis of the data collected for cement D-5400 psi showed the cement to be too strong for the temporary cementation of temporary and other restorations. There was some indication that this cement might serve for the final cementation of finished restorations. It was, therefore, recommended that further data be collected for this cement as a final cement for finished restorations. Conversations regarding results and recommendations in this preliminary report were held and further investigations were undertaken on a 12 month basis, September 1, 1965. The study can be described conveniently in four sections: I. Preliminary laboratory investigation to determine the proportions of the new cements which would give optimum handling qualities. II. Clinical study to observe temporary cementations of various temporary restorations with cements C-2200 and E-3500 with regard to retention and taste. III. Clinical study to observe temporary cementation of various finished dental restoration with cements of various crushing strengths, with regard to retention, longevity of service, relative ease of removal and cleansing of abutments and retainer after removal. IV. Clinical study to observe final cementations of finished restorations with cement F-8000 and recementations with F-9200. 1

I. PRELIMINARY LA'ORATORY INVESTIGATION The manufacturer supplied additional materials to be included in the study. One new paste, three new powders and one new liquid were provided. The new liquid was to be used with all powders in the second clinical study. The purpose of the preliminary laboratory investigation was to determine the proportions of the new materials which would give optimum handling qualities. A. MATERIALS A new paste catalyzer and paste base material, D1-9, was made available. A new liquid, 166-45, Lot 166-187, and a new liquid dispensing device were furnished. Three new powders became available, 166-181, 166-182 and 166-186. A list of the materials in the laboratory study appears in Table I. B. METHODS Trial mixes were made of the new paste cement Dl-9 in varying proportions of the base and catalyst. The mixes obtained were examined in regard to ease of mixing, mixing time, working time, setting time and consistency. Ease of mixing and mixing time were evaluated by the criterion of complete dispersion of the catalyst in the base by normal spatulation having been accomplished in 30-45 seconds. Working time was determined by the application of a dental mandrel to the mix at 30 second intervals. The time at which the cement no longer adhered to the mandrel on withdrawal was recorded as the working time. The setting time was recorded when the mandrel would no longer penetrate the cement mass. Consistency was evaluated by observation of the flow qualities of the freshly mixed cement from a spatula. The new squeeze-dropper bottle was calibrated so that known milliliter quantities could be dispensed by counting drops (Table II). Using this method of liquid proportioning, weighed quantities of the five powders were mixed with the liquid. These mixes were also evaluated with regard to time, working time, setting time and consistency. The values obtained for initial set and final set are shown in Table III. Film thickness tests were done on the cement selected for final cementation procedures using the method described in the A.'D.A. Specification No. 8 for zinc phosphate cements, see Table IV. 2

C. RESULTS From the data obtained on these tests, all cements met the following criteria: 1. Easy to mix in 30-45 seco 2. Consistency creamy but not so freely flowing that it would drip from restorations when filled and inverted as in cementing to place. 3. Working time not less than 2-1/2 min and not more than 8-1/2 min. 4. Film thickness satisfactory for adequate seating of restorations at cementation. 5. By varying proportions only, various crushing strengths were obtainable in cements "G" and "Fott During conversations in October, 1965, it was decided to use neither the original nor the improved cements of 5400 psi compressive strength. Observation of those cementations still in the mouth from the previous preliminary study of the 5400 psi cement was to continue. It was also decided to continue the investigation of the original 3500 psi cement and not substitute the modified 3500 psi cement. Proportions were mixed at the conference table and a powder liquid ratio selected for the new F-8000 cement, Table V shows the proportions used in the clinical investigations. 3

II. TEMPORARY CEMKNTATIOGN OF TEMPORARY RESTmORATIONS This sec-tion of the clinical study collected data for cement C-2200 and E-3500 when used for the temporary ce(-mentation of temporary restorations. A. MATERIALS Cement powder C-220C was dispensed in glass vials. each containing 0. 6 gram of powder~ This quantipowde powder was spatullated into 115 drops (3 ml) of liquid, Cenment E-3500 powder was also dispensed in glass vials, each containing 0.6 gram powder. This qulant+ity of powder was spatulated ito 13 drops (3 ml) of liquid. B. METHODS 1.G Assignment of Cements Either cement C-220j or E-73 0 was selected at random for eachb patient. Whlen subsequent cementation of tempc-rary restoratiojns was required in. the same patient, the alternate cement was assignled. From the data collected or' each patient, a. single cementation with each cement was selected for inclus:ion- in trhoe study by a standard pattern. In this way each cementation recorded fe-1 tt1le analys]i s of dat a r. epresented one cementation of one temporary restoratiorn on one too+t1h by ore operatcor. No tooth was selected twice in the s-tudy. This pro-edure in. selecit.in'g data ensured an analysis on the basis of "single u.se," Arl instruction sheet3 outl.ininig the assig nment prnoc du.re and the proportioning and mixing of the cements, was given to, each. student,., A G'opy of the sheet is shown in Figure 13 page 68, 2. Data Collected at Cementation Ao The investigator observed completed abutment preparations at the chairsideo Records were kept of tLhe following factors. 1. Arch location of each preparation. 20 Type of each preparation.

3. Retentive qualities of each preparation. B. Operators were questioned regarding the following factors: 1. Mixing-easy or difficult. 2. Working time-adequate or inadequate. 3. Removal of excess cement-easy or difficult. 4. Did patient make unsolicited comment of a burning taste? 3. Data Collected at Removal of Temporary Restoration The investigator questioned the operator and/or patient at the time of removal of the restoration, regarding these factors: 1. Did cementation succeed (remain tight with marginal seals intact)? How long? 2. Did cementation fail? How long before failure? 3. How was removal done? With ease or with difficulty? 4. How readily was the cut dentin surface cleaned? With ease or with difficulty? 5. How did the restoration clean if required for recementing? With ease or with difficulty? 6. Did the cement change the color of acrylic of temporary restoration when used? Yes or No. 4. Data Collection Data collection was accomplished and controlled by two forms: a data sheet 8/65 C&E and a work sheet 8/65(2) Cont. C,E which are shown in Figures 2 and 3. The method of using these forms is outlined in the appendix, page 68. C. RESULTS Three hundred thirty-five temporary restorations were selected as described above. Cement C-2200 was used for 176 restorations and cement E-300 for 139 restorations. The data selected is analyzed in Graphs, I, II, III, and IV 5

(pages 45-48). The data for all types of restorations are shown in Graph I. It can be seen that in the case of cement C-2200 there were 161 successful cementations and 15 failures. With cement E-3500 there were 145 successful cementations and 14 failures. The data for acrylic restorations is shown in Graph II. With cement C-2200 there were 73 successful cementations and 11 failures. For cement E-3500 there were 78 successful cementations and 10 failures. The data collected on the cementation of aluminum crowns is shown in Graph III. It can be seen that with cement C-2200 there were 88 successful cementations and 4 failures and that with cement E-3500 there were 68 successful cementations and 4 failures. The data regarding taste is shown in Graph IV. Cement C-2200 was used for 176 cementations. Local anesthesia had been used in 21 instances. In the remaining 133 cementations a burning sensation was experienced 44 times. Cement E-3500 was used 159 times. In 12 instances local anesthesia had been used. Of the 147 remaining cementations a burning sensation was experienced in 36 instances. Two patients were sensitive to the cements and developed reactions which prohibited the further use of' the cement. An analysis of the acrylic temporary restorations is given in Table VI. The following factors are shown: the type of cement; the type of preparation; number of days in place; retentive value of the preparation; success or failure (i.e., stayed in place for required period). An analysis of the aluminum temporary crowns is given in Table VII in which the same factors listed in the previous table are shown. An analysis of the data collected at the removal of the acrylic temporary restorations is shown in Table VIII. The following factors are listed: type of cement; ease of removal; ease of cleaning the dentin; ease of cleaning the temporary restoration when required and the type of preparation. An analysis of the data at the removal of the aluminum temporary crowns is shown in Table IX where the same factors are listed as in the previous table. D. DISCUSSION Only differences of statistical insignificance appeared between the two cements, C-2200 and E-3500 when used for temporary cementation of temporary restorations from the standpoints of retention and taste. Both cements were nearly equally adequate for the cementation of temporary restorations. The operators seemed more enthusiastic about cement E. Delight was expressed on many occasions by the operators in that less eruption of teeth into one of the gummier materials also used as a temporary cement was experienced 6

when either C-2200 or E-3500 was used. At the removal of acrylic restorations only two restorations were ruined, one which had been cemented with each cement. Six came off with difficulty cemented with cement C-2200, while 8 came off with difficulty cemented with cement E-3500. Dentin cleaning was insignificantly different, both cements giving difficulty on three occasions. In all six instances, these problems were the result of excessive desiccation of the dentin prior to cementation of the temporary restoration. Two aluminum crowns were ruined at removal. They had been on with cement C-2200. Ten removed with difficulty, being held by cement C-2200 while only 5 gave trouble held by cement E-3500. The dentin cleaned with difficulty eight times with C-2200 and three times with E-3500. The cleansing of the alumimum crown for reuse appeared more difficult with C-2200, two alumimum crowns having been ruined and four others giving difficulty. E cement gave no difficulty in this regard. No statistically significant difference was apparent between cements C-2200 and E-3500 in regard to retention or taste. Temporary restorations cemented with either cement were held in place for the required period with equal frequency. From the recorded comments of the operators, it would appear that cement E-3500 was the subject of more favorable comments in regard to general handling qualities than cement C-2200. Only two acrylic restorations were ruined during removal, one restoration with each of the cements. Six acrylic restorations were removed with difficulty after cementation with C-2200; eight were removed with difficulty after cementation with E-3500o No significant difference was recorded of the ease of cleaning the dentin. Two aluminum crowns cemented with C-2200 were ruined at removal. Ten crowns cemented with C-2200 were removed with difficulty. Five crowns cemented with E-3500 were removed with difficulty. Difficulty in cleaning the dentin was experienced eight times with C-2200 and three times with E-3500. Two aluminum crowns were ruined in cleaning -the restoration for reuse following cementation with C-2200 and four crowns gave difficulty in cleaning. No difficulty was experienced with E cement in this regard. E. CONCLUSIONS 1. No statistically s ignificant difference was evident between cement C-2200 and cement E-3500 when used for temporary cementation of temporary restorations 2. Both cements proved adequate for the temporary cementation of temporary restorations. 7

3. More favorable comments were received from the operators in regard to cement E-3500 than cement C-2200.

III. TEMPORARY CEMENTATION OF FINISHED RESTORATIONS This section of the clinical investigation collected data on the use of zinc oxide-eugenol cements of various crushing strengths for the temporary cementation of finished restorations. Each of these several cements was studied in regard to: 1. Retentive capabilities, ieo,, would it hold the restoration. 2. Facility of removal of cemented restoration when. required. 3. Facility of cleansing the dentin prior to final cementation. 4. Facility of cleansing the restoration for recementation. A. MATERIALS The cements used in this section of the study are shown in Table V and numbered 2, 4 53, 6, 7, 8, and 9. The proportions used are indicated in the table. Bo METHODS 1, Assignments of Cements The cements were assigned in relation to the following factors: l.o Type, location and number of retainerso 2. Retentive qualities of retainers. 3. Length of and number of spans. 40 Amount of occlusal stress anticipated, Time temporary cementation was expected to remain in place. 2, Data Collection at Cementation The investigators graded the retention of the preparat;ions and finished restoration at the chairside when the cement assignment was made. Records were 9

kept on data sheet 8/65 (see Fig. 5, page 72). The mechanics of' this data collection appears in the appendix, page 71, and examples are shown, pages 57-59o Student comments in sections 9 (working time) and patient comments in section 10 (taste) were recorded only when volunteered. 35 Data Collection at Recall Examination Two methods were used: (a) For short term temporary cementations (under 45 days), and (b) Long term temporary cementations (at the time of this writing up to 18 months)~ a. Short Term Temporary Cementations-Patient comments and operator comments when questioned regarding the cementation furnished the information for this data. Factors in questioning were as follows: 1. Did restoration stay in place? How long? 2. Were marginal seals intact with no cement wash-out at margins? (Cavosurfaces of abutments and retainers were examined by operators following removal of cemented restoration). 35 Was removal done with ease or with difficulty? 4o Was cleansing of cut dentin of abutments done with ease or with difficulty? 5. Was cleansing of restoration for re-cementation done with ease or with difficulty? b Long Term Temporar Cementations-Periodic recall examination by investigator furnished data on these cases. The patients were advised at the time of cementation to contact the investigators if any of the following signs appeared between recalls: 1. Sensitivity of abutments to temperature changes, fruit acids or sweets. 2. Unusual taste around abutments. 3. Feeling of "looseness " or movement of the restoration. On recall examination of the long-term cementations, the restorations were examined for loose retainers by one of the investigators. The following procedure was used: excess saliva was cleaned from the environment of the restoration by an air syringe. Each retainer was in turn subjected to traction and pressure in the line of draw of the restoration. A loose retainer was readily detected by the movement of residual saliva across the gold-tooth interface. 10

Traction was applied to the restoration with a 5S burnisher or an S.SW. B scaler with a force of approximately 8 lb. Pressure was applied by having the patient bite firmly on a 1/4-inch diameter orangewood stick. The patient was questioned regarding comfort, sensitivity of teeth, unusual taste9 and any other symptoms. Twenty-one of the long term temporary cementations remain cemented. The restorations are removed and finally cemented only when failure of the temporary cementation is suspected and removal is thought advisable by the examiner. Two of these 21 no longer can be followed, however. Co RESULTS Two hundred and twenty-three inlays, bridges and crowns were temporarily cemented representing six hundred and fourteen units of inlay, crown and/or bridge work on three hundred and seventy four retainers. Two hundred and two inlays, bridges or crowns have been removed or have failed and twenty-one remain in place. The data regarding these restorations in Tables X, XI, XII, XIII, XIV, and XVo The cements used in the study are listed in. the first column in Table Xo The next three columns show the types of restorations cemented: singles (individual inlays or crowns), bridges and splints. Column 5 gives total cementations, colums 6 and 7 successes and failures, The percentage failures indicated in the column to the far right of this page are gross calculations. Since these disregard the type of each restoration, the retentive qualities. the occlusal environment and the time expectancy of the temporary cementation, the percentages serve mainly as a measure of the level of subjective judgment in the selective assignment of the several cements and not as an index of their relative efficiency, per seo Table XI further analyzes these data on successes and failures, breaking them down into types of restorations temporarily cemented. No time period is shown for the successes, since the restoration remained in place for the required time. The time interval between cementation and failure is shown in the last -two columns, Table XII shows further analysis of the data on the failures, indicating if the restoration dislodged into the mouth, how many retainers loosened and whether the patient or the examiner discovered the failure. Table XIII gives the results of ease or difficulty of removal of successful temporary cementations, the dentinal cleansing and cleansing of the restoration in fractional form. Easy appears as numerator and difficulty appears as the denominator. Table XIV gives details of restorations still temporally cemented. Time 11

is indicated in the column at the far right. Table XV breaks down all temporarily cemented bridges into fixation types, for interest only. 4, Data Processing The data was transferred to IBM cards via a system which is described in detail in the appendix? pages xiv to xxio As will be seen in this description, the follow-=up recall examrination informnation is added to the original IBM card containiing the original information at cementation, Duplicates of IBM cards have been mailed to the sponsor: (1) When cementations were placed, and (2) when additional information procured at recall examinations was obtained and added, D. DISCUSSION The number of times each of the cements was utilized can be seen in Table X (total cementations) Cement A-1000 was selected most frequently (61 times) with the other cements in the following order: G-400 (35 times), B-200 (34-times), C-2200 (31 times), G-600 (21-times), E-3500 (11 times), F-8000 (7 times), D-5400 ( 2 times). Care was required to select a cement which would allow easy removal of the restoration when required. Selection of too weak a cement, however, would invite loosening of the restoration. The investigators endeavored to select the strongest cement for each case which in the light of previous experience -with similar situations could be removed easily. An examination of the data collected at the time the restorations were removed (Table XIiI) gives some indication of the success of this judgment. In the 47 successful cementations with cement A-1000 difficulty in removal was experienced on only two occasions, In the various cementations with cements B-200, G-400, G-600, D-5400, and F-8000, no difficulty was experienced in any removalso In the case of cement C-2200, 9 of the 26 removals presented difficulties, however 9 this cement was used three times without assignment by an investigator and this data is included. Three out of seven cementations with cement E-3500 were difficult to remove. One of these, however, was not assigned by an investigator. In the few cases in which the two strongest cements (D-5400 and F-8000) were employed no difficulty in removal was experienced, It might be thought that the highest incidence of difficulty might be found here, but these cements were only resorted to in cases which had very poor retentive quality, some of which were to be modified and remade. 12

When too weak a cement was selected the cement lute was broken and an examination of Table X reveals the incidence of failure with each cement, The incidence of failure varied from 0% with the case cemented with D-5400 to 36% with cement E-3500. Many of the failures were successfully recemented with the next stronger cement. A detailed analysis of all cases is given in. Table XI where the type of restoration and time periods involved are listed. None of the cements presented significant difficulties in cleaning either the dentin or the restoration (Table XIII)o Where difficulty in cleaning the dentin was experienced it was noted that excessive drying of the dentin had occurred. E. CONCLUSIONS 1. Cement A-1000 most frequently met the requirements of the cases in this study. 2. Cements B-200, G-400, G-6009 C-2200, and E-3500 were selected with sufficient frequency to indicate the need for cements over this range of compressive strengths to be available if all clinical needs are to be met. 3. Cements D-5400 and F-8000 should not be regarded as required for the temporary cementation of normal clinical caseso 4. Selection of a cement for the temporary cementation of a restoration can be made on an evaluation of the retentive quality of the restoration and the occlusal stresses to which it will be subjected. The clinician is required to develop his own judgment in this regard' utilizing the accepted criteria by which the retention of restorations is evaluated. The nature and extent of occlusal stresses are perhaps more difficult to assess and suitable criteria are not yet available, 5. None of the cements presented difficulties in handling nor in removal from dentin or restoration when required. 13

IV. FINAL CEMENTATION OF FINISHED RESTORATIONS In this section of the clinical investigation data was collected on the use of zinc oxide-eugenol cements for the final cementation of finished restorations. These cements were studied for their retentive qualities and note was taken of any symptoms which arose at the time of cementation or thereafter. A, MATERIALS One cement powder and one liquid were used. By altering the powder liquid ratio, the following two crushing strengths were obtained (see Table V, page 25). F-8000 - 0.9 gram powder/30J7 m (16 drops) liquid gave a cement of 8000 psi (approxo) F-9200 - 0o9 gram powder/30O ml (13 drops) liquid gave a cement of 9200 psi. B. METHODS 1, Patient Selection Patients were selected who would be available for recall examination for a minimum period of 2 yearso No other criteria were used and all types of inlays9 crowns., and bridges were accepted in the study. 2o Assignment of Cements Cement F-800Q This cement was given to undergraduate students for the cementation of inlays, crowns and bridges. Cement F-9200-The higher powder liquid ratio of this cement produced a more viscous material which was assigned only to graduate students and staff in selected cases. The cement was not assigned in. the following situations: Ao Thin procelain jacket crowns. B. Pinledge restorations with parallel sided pins. 35 Mixing the Cement One vial of cement powder (0O9 gram) was incroporated into 16 drops of liquid (3~7 ml) using a parchment pad and a Kerr spatula. All the powder was 14

brought into the liquid and compressed repeatedly until moistened and the moist mass was spatulated rapidly. The mix was completed in 30-45 seco 40 Mouth Preparation The area involved was isolated with cotton rolls and a saliva ejector placed. The teeth and adjacent tissues were thoroughly dried with cotton. The abutment teeth were further dried with cotton and a sterilzing agent applied where required. No varnish was applied to the abutments. Local anesthesia was not used routinely. 5o Data Collection at Cementat ion The preparations were graded at the chairside prior to final cementation.. Records were made on a data sheet) Figure 5. The mechanics of this data collection appears in the appendix, page 71' and an examplie is shown on page 58. 6, Data Collection at Follow-up Examination The patients are being systematically recalled for examination of the cemented restorations. On recall examination of the cementations9 the restorations were examined for loose retainers. The following procedure was used: excess saliva was cleaned from the environment of the restoration by an air syringe, Each retainer was in turn subjected to traction and pressure in the line of draw of the restoration~ A loose retainer was readily detected by the movement of residual saliva across the gold-tooth interface. Traction was applied to the restoration with a 5S burnisher or an SOSW B scaler with a force of approximately 8 lb. Pressure was applied by having the patient bite firmly on a 1/4-inch diameter orangewood stick, The patient was questioned regarding comfort5 sensitivity of teeth, unusual taste) and any other symptoms. 7. Data Processing The data collected at the time of cementation was transferred to IBM cards, using a system which is described in the appendix, page 60o The follow-utp examination findings are added to the original IBM card containing the information recorded at cementation of the restoration~. Duplicates of the IBM cards were mailed to the sponsor following cementation and after additional information5 procured at recall examinations, was added. 15

C. RESULTS By December 16, 1966, 246 restorations had been finally cemented. This figure includes two restorations which were finally cemented with D-5400 during the preliminary study and were being followed by recall examination. The 246 cementations involved placement of 790 units of inlay, crown and/or bridge work on 490 retainers for 186 patients. The time, which has elapsed since cementation, varies from 13 months with the earliest restorations cemented in the study to 2 days for the most recent restorations cemented. It can be seen that a wide variety of restorations, both single and multiple, are included in the study. The many factors which can be identified and examined are set out in Tables XVI to XXIVo Tables XVI and XVIi show the cement used, the number of restorations cemented with each cement, the number of units in each restoration and the total number of retainers cemented for each type of restoration. Tables XVIII through XXIV show a further analysis of the data on the restoations cemented. Table XVIII gives the number of spans in each bridge. Table XIX shows the number of pontics in the longest span. Table XX shows the type of fixation, Table XXI shows the retention grades of the restorations. Table XXII shows the location in the arch of the restorations. Table XXIII shows the occlusal function grades and Table XXIV gives the student and/or patient reaction to the cement. All restorations were completely seated without difficulty. It is well to bear in mind, however, that the heavier bodied F-9200 cement was employed only by experienced dentistso A remarkable absence of pain at cementation was noted. Numerous cementations were made on hypersensitive abutment teeth and no discomfort was experienced by the patients. Many patients commented on the feeling of comfort which they experienced immediately the restoration had been cemented. Local anesthesia was not routinely used even in the more extensive restoations. Although some discomfort was occasionally experienced during the period prior to cementation when a number of abutments were isolated, immediate relief was experienced when the restoration was cemented to place. Three exceptions, all related to cementation of pinledge restorations, occurred~ In two cases transient pain was experienced which subsided rapidly once the restoration was completely seated. It is thoughtthat hydraulic pressure on the pulp through the dentin was produced as the pins went to place. In 16

the third case acute pain occurred at the time of cementation and persisted for some time. The final effect was not determined as the patient failed to attend for subsequent appointments. By December 16, 1966, 101 patients have been seen for follow-up examinations. Of the 490 retainers cemented, 255 have been tested for adequacy of the cements from the standpoint of retention, By adding the entries in Table XXVI it can be found that 92 bridges have been examined at recall and 31 single restorations have been examined. The cement successfully luted 83 or 90.2% of the bridges. None of the single restorations had loosened or showed signs or symptoms of marginal leakage. Of the 255 cemented retainers, 13 or 5% involving 9 bridges, failed. Of the 9 bridges, 2 were dislodged into the mouth and were brought in by the patients. The failure of the other 7 was detected at the r ecall examination. Eight of the 9 bridges have been recemented with F-9200 cement and are presently being followed by recall examination. No dental caries was found beneath the retainers which failed. The details of the 9 bridges which failed are shown in Table XXVo The bridge listed in lines 1 and 2 of Table XXV failed following cementation with D-5400. Failure occurred after recementation with F-8000o Following this second failure the bridge was recemented with F-9200 and is still in place awaiting recall. Bridge number 3 was retained by two pinledge restorations on the maxillary cuspids. The retention of the pinledges was grade 4, short, parallel, with ample surface to grasp. The occlusion grade was 5 (holds less than half the occlusion) and the patient bruxes on the restoration. Bridge number 4 was a 5-unit mandibular posterior restoration, with two splinted bicuspid abutments at the mesial end and a crown on the third molar at the distal end. A molar and a bicuspid pontic section was attached with rigid connectors. The two bicupsid retainers loosened, the molar crown remaining in place. This bridge is presently recemented with F-9200 cement. Bridge number 5 dislodged into the patient s mouth during a meal. The occlusion had not been properly balanced at the time of cementation. Bridge number 6 stayed in place 10 months before dislodging into the mouth. Retentive factors were of the lowest grade. The restoration is presently in place having been recemented with'F-9200 cement. Bridge number 7 remained in place 91 days before it was dislodged by the investigator during a follow-up examination~ It has been recemented with F-9200 cement and is under observation. 17

Bridge number 8 had the less retentive of two dissimilar retainers loosen in 6 months, while bridge 9, a similar restoration, remained secure for 9 months before the less retentive retainer loosened. Table XXVI gives a break down of the examinations of the successes for the two cements used. The fractional expressions in the first column indicate the number of units over the number of retainers in the restoration. Those fractions in the 2nd and 3rd columns indicate the number of months following cementation over the number of restorations examined. Table XXVII shows the number of restorations and retainers examined at varying time intervals after cementation. DI DISCUSSION it can be seen from Tables XVI and XVII that a wide variety of restorations were cemented varying from single restorations to multiple span bridges with as many as 14 units. As might be expected in an undergraduate clinic the highest number of restorations were three-unit bridges. with single restorations second in number. JTable XVIL shows that 69 of the bridges were single span bridges, 12 involved 2 spans and 4 involved 3 spans. Table XIX shows that 135 bridges had one pontic span, 31 had 2 pontic spans, 5 had 3 pontic spans, and 14 had 4 pontic spanso Table XX shows that 167 bridges had rigid connectors, 7 had a semi-rigid connector, and several othe relations between retainer and pontic were represented in the sample. Table XXI shows the distribution of retention grades among the various cases and it can be seen that all conditions are reported in the cases studied. Table XXII shows the location of the bridges in the arch and it is interesting to notice that the majority of the bridges are in the posterior section of the arch (8), Bridges next in frequency are located in the anterior section of the arch (6) while 34 bridges located posteriorly include the cuspid as an abutment. The bridge retainers utilized include three-quarter crowns, complete crowns, veneer crowns and inlays, Single restorations include all of these and in addition procelain jacket crowns. It can be seen that a wide range of all types of restorations, both bridges and single units were included in the study. From the results already presented it was noted that the cement was remarkably bland to tooth tissue and pain at cementation was absent in the majority of cases, In addition post-cementation pain was similarly reduced to virtual nonoccurrence 18

Of the 255 cemented inlays, crowns and bridge retainers in patients who have been recalled and examined 13 or 5% failed. All 13 failures were bridge retainers. None of the 27 single restorations had failed. It is interesting to examine the nature of the bridges which failed (Table XXV). The bridge listed in lines 1 and 2 extended from the right maxillary cuspid to the left second bicuspid with the left cuspid as an intermediate abutment. Because of the other missing teeth all function was on the left side. It is possible that functional forces exerted displacing forces on the single abutment on the right side. The retainers on the left side remained secure. Bridge number 3 is a six-unit anterior maxillary bridge replacing the four incisors. Although the retention grade was next to the highest, the occlusion on the bridge was heavy and the patient bruxedo In bridge number 4 the retention grade for the retainer was 4 and the occlusion was grade 2 with a crossbiteo In bridge number 5 the retention grade for the retainers was 4 and the occlusion was grade 1 but the pontic was left high. In bridge number 6 the retention grade of the retainers was 9 and occlusion grade 1. In bridge 7 the retainer retention grade was 4 occlusion grade was 4. In bridge number 8 the retention of the restoration was grade 4, occlusion was on a denture, grade 4. It can be seen that among the retainers on the bridges which failed none had a retention grade higher than 4 and in two cases the retention grade was lower than 4. In four of the bridges there was other than normal occlusal conditions. All except one of the failing bridges were recemented with F-9200 and are still in position. E. CONCLUSIONS 1l The cements tested were nonirritating to freshly cut dentin. 2. The cements showed a sedative effect on sensitive abutments. 3. The cements securely luted 90.2% of the 92 bridges which have been recalled to date. 4o Thirty-one (100%) of the single restorations were successfully luted. 5o No signs or symptoms of marginal leakage were evident in any case other 19

than those which failed. 6. No caries was found in any of the bridges which had failed. 20

TABLE I CEMENTS IN LABORATORY STUDY Io Paste Catalyser Paste Base D- 9 (New "G' ) IIo Powders 166-186 ( New'IF") 166-181 (Altered "D" —sent back) 166-182 (Altered "E —sent back) 166-44-2 (Lot, 166-120-A) old IC" used 166-43-2 (Lot, 166-123-A) old "E" used III. Liquids 166-45 (Lot, 166-187) new liquid to be used with all powders 21

TABLE II DROPPER CALIBRATION A 5 cc graduate cylinder was obtained to calibrate the dropperso The trial measurements were made as follows: Trial Drops Milliliters Dropper No" i 1 45 1o 1 2 45 1.2 3 42 loO 4 39 0.9 5 39 0.9 6 39 0.9 Dropper Noo 2 1 39 0.90 2 39 0.90 3 39 0.90 Dropper No. 3 1 16 0.37 2 16 o.38 3 16 0.37 4 153 0.30 5 13 0.29 6 13 0.31 7 13 0.30 22

TABLE III LABORATORY MIXES Paste Cements Minutes Minutes Ceme nt Base Catalyst Initial Set Final Set D 1-9 1 part 1 part 4.5- 6.5 7.5- 9.0 (G) 2 parts 1 part 7.5-10.59.0-12.0 1-1/2 parts 1 part 5.5- 6.5 8.0-12.0 Powder/Liquid Cements Minutes Minutes Cement Powder Liquid Proportions Initial Set Final Set Initial Set Final Set Altered 166 -182 166-45 0.6 gram/3ml 2' 75-3.0.0 "E" or 166-43-4 (166-187) (166-123-B) Old "tE" 166-43-2 166-45 0o6 gram/3 ml 2o0 2.5 (166-123-A) (166-187) "C" 166-44-2 166-45 0.6 gram/3 ml 3.0 3.5 (166-120-A) (166-187) Altered 166-181 166-45 0.6 gram/3 ml 2.5 3.0 "D" or 166-43-4 (166-187) (166-123-B) F-9200 166-186 166-45 0.9 gram/3 ml 4.5-5.5 5.0-5.5 (166-187) 6.5-7.0 7.0-7.5 F-8000 166-186 166-45 0.6 gram/3 ml 6.5-7~0 7.0-7.5 23

TABLE IV FILM THICKNESS, CEMENT F (Room temperature, 760F, 44% rel. humidity, load 2 kg (33 lb) on 2 cm2 applied 3 min after mix) 0.9 Gram Powder With 13 Drops Liquid 0 9 Gram Powder With 19 Drops Liquid Test (3 ml), Thickness (mm) (4o4 ml), Thickness (mm) With Cement Without Cement With Cement Without Cement 1 lo 930 o 955 2 040 20 o60 2 1 930 1 955 2 04 2e 04 06 3 1.930 1.955 2.040 2.0 o55 4 1.930 1.950 2.040 2.055 5 1.930 1.955 2.035 2.055 Film thickness = 24 microns Film thickness = 18 microns Note: AD.Ao. specification noo 8 test procedure for film thickness. 24

TABLE V CEMENTS SELECTED FOR THE CLINCIAL STUDIES IBM Code Paste Powder Liquid Proportions No. 1 F-9200 166-186 166-45 0.9 gram powder Lot D-1-4 Lot 166-187 3.0 ml liquid (13 drops) 2 F-8000 166-1 166-45 0.9 gram powder Lot D-1-4 Lot 166-187 3~ 7 ml liquid (16 drops) 3 D-5400 166-43-4 166-45-2 0.6 gram powder Lot 166-123-B Lot 166-120-D 0.3 ml liquid (dropper change) Observation of existing cementations only 4 E-3500 166-43-2 166-45 0.6 gram powder Lot 166-123-A Lot 166-187 3 ml liquid (13 drops) 5 C-2200 166-44-2 166-45 0.6 gram powder Lot 166-120-A Lot 166-187 3 ml liquid (13 drops) 6 A-1000 166-117 Equal lengths'base and catalyst 7 G-600 D-l-9 1-1/2 lengths base to 1 length catalyst 8 G-400 D-l-9 Equal lengths base and catalyst 9 B-200 166-121 Equal lengths base and catalyst

TABLE VI ACRYLIC TEMPORARY RESTORATIONS Cement C-2200 Cement E-3500 Type of Retention of Preparation Retention of Preparation Preparation A B C D A B C D S* F** S F S F SF S F S F S F S F 0-3 1 4 5 0 1 3 Complete 4-7 3 0 8 0 5 1 1 0 2 0 4 0 4 2 Crown 8-14 2 0 3 0 4 0 1 0 4 1 2 0 > 14 3 0 1 0 5 0 2 0 1 0 Totals 5 0 15 4 9 1 1 0 4 0 18 1 9 5 1 0 Three 03 4 o 4 1 1 o 2 0 2 0 4-7 2 0 1 0 1 0 2 0 3 1 5 0 Quarter 8-14 1 0 1 0 2 0 2 0 6 0 > 14 3 0 2 0 1 0 2 0 4 1 Totals 10 0 8 1 5 0 8 0 15 2 5 0 Moo D. o ~3 1 0 3 0 2 0 3 2 Inlay 4-7 2 1 1 1 2 0 2 0 Protected 8-14 2 0 1 0 4 0 Cusp > 14 0 1 Totals 3 1 6 2 1 0 4 O 9 2 0-3 2 0 2 1 1 0 0 1 4-7 2 0 Pinledge 8-14 2 0 2 0 1 0 1 0 > 14 1 o Totals 4 0 50 1 1 0 3 0 *Successful cementations o **Failure of cementationso 26

TABLE VII ALUMINUM TEMPORARY RESTORATIONS Cement C-2200 Cement E-3500 Type of Retention of Preparation Retention of Preparation Days Preparation A B C D A B C D S* S** S F S F S F S F S F S F S F 0-3 4 1 1 o 1 o 1 0 4 o 11 Crown 4-7 3 0 13 o 6 o 2 0 91 4 0 Crown 8-14 7 0 2 0 1 10 1 0 1 0 > 14 3 0 2 0 1 0 2 0 1 0 Totals 3 0 27 111 0 2 0 5 0 15 1 6 12 0 Three 0-3 2 0 5 o 1 0 4 o Three 4-7 3 0 7020 60 70 0 1 ter 8-14 2 0 5 1 1 0 1 0 4 o 1 o Crown Crown> 14 1 o 3 1 4 o Totals 8 0 20 2 3 0 8 o 19 0 1 o o 1 M.O.D. 0-3 1 1 4 0 2 0 2 0 1 0 Inlay 4-7 2 0 6 0 2 0 4 0 0 1 Protected 8-14 1 0 1 0 Cusp > 14 Totals 4 1 10 0 4 0 7 0 1 1 *Successful cementations. **Failure of cementations. 27

TABE'VIIi DATA AT REMOVAL ACRYLIC TEMPORARY RESTORATIONS Cement C-2200 Type of Removal Dentin Cleaned Restoration Cleaned Preparation Ruin Ruin No Easy Difficult Easy Difficult Easy Difficult Restoration Restoration Clno Crown 28 2 0 29 1 29 0 0 1 3/4 Crown 21 1 1 -22 1 21 0 0 2 PC MoOoD. 8 2 0 9 1 8 1 0 1 Pinledge 1 0 1 8 1 0 1 Total 66 6 1 69 4 66 2 0 5 Co Cement E-3500 Crown 28 4 0 31 1 30 0 0 2 3/4 Crown 25 2 1 27 1 27 0 0 1 PC MoO.D. 11 2 0 12 1 10 1 0 2 Pinledge 4 0 0 4L 0 4 0 0 O Total 68 8 1 74 3 71 1 0 5

TABLE IX DATA AT REMOVAL ALUMINUM TEM[PORARY RESTORATIONS Cement C-2200 Type of Removal Dentin Cleaned Restoration Cleaned Preparation Ruin Ruin No asy Difficult R in Easy Difficult Easy Difficult R i Restoration Restoration Clno Crown 34 7 2 39 4 34 3 2 4 3/4 Crown 28 3 0 27 4 26 1 0 4 PC MoOD. 14 0 0 14 0 14 0 0 0 Total 76 10 2 80 8 74 4 2 8 Ro Cement E-3500 Crown 26 2 0 27 7 26 0 0 2 3/4 Crown 26 2 0 27 1 24 0 0 4 PC MO.D. 11 1 0 11 1 11 0 0 1 Total 63 5 0 65 3 61 0 0 7

TABLE X COMPLETED TEMPORARY CEMENTATIONS OF FINISHED RESTORATIONS, SUCCESSES AND FAILURES Restorations Cemented Total Cement Singles Bridges Splints Cementations Successes Failures B-200 7 25 2 34 25 9 = 25% G-400 15 18 2 35 28 7 = 20% G-600 12 9 0 21 17 4 = 19% A.-1000 20 38 3 61 47 14 = 20% C-2200 12 17 2 31 26 5 = 16% E-3500 2 9 0 11 7 4 = 36% D-5400 1 1 0 2 2 0 = 0% F-800 0 0 5 2 = 30 Total 69 124 9 202 157 45 30

TABLE XI COMPLETED TEMPORARY CEMENTATIONS OF FINISHED RESTORATIONS, ANALYSIS OF SUCCESSES AND FAILURES Successes (1 day to 18 months) Failures Time of Failure Cement No. of Type of No. of Type of Days Months Restorations Restorations Restorations Restorations B-200 6 Single tooth 1 Single tooth 1 restoration restoration 2 2-unit bridges 8 3-unit bridges 2 3-unit bridges 1 2 4-unit bridges 1 4 5-unit bridges 1 4-unit bridges 3-1/2 1 6-unit bridges 1 7-unit bridge 3 3 8-unit bridges 1 i0-unit bridge 4 1 11-unit bridge 1 13-unit bridge 4 Total, 34 G-400 14 Single tooth 1 Single tooth 21 restorations restorations 2 2-unit bridges 4 3-unit bridges 2 3-unit bridges 1,4 4 4-unit bridges 2 4-unit bridges 1,7 4 5-unit bridges 1 5-unit bridges 10 1 13-unit bridge 4 Total, 35 G-600 10 Single tooth 2 Single tooth 2,3 restoration restoration 4 3-unit bridges 2 4-unit bridges 1 4-unit bridge 90 1 5-unit bridges 1 11-unit bridge 11 Total, 21 A-1000 19 Single tooth 2 Single tooth 54,55 restoration restoration 2 2-unit splints 1 single 1 1 2-unit bridge 1 19 3-unit bridges 7 3-unit bridges 1-95 5 4-unit bridges 1 4-unit bridges 10 2 5-unit bridges 1 5-unit bridge 24 1 6-unit bridge 1 11-unit bridges 1 13-unit bridge 11 Total, 61 C-2200 12 Single tooth restoration 2 2-unit bridges 8 3-unit bridges 3 3-unit bridges 2,12,14 2 4-unit bridges 35,59 4 5-unit bridges Total, 31 31

TABLE XI (Concluded) Successes (1 day to 18 months) Failures Time of Failures Cement No. of Type of No. of Type of Restorations Restorations Restorations Restorations E-3500 2 Single tooth restoration 2 3-unit bridges 3 3-unit bridges 7,10,72 2 4-unit bridges 1 4-unit bridge 1 5-unit bridge Total, 7 D-5400 1 Single tooth restoration No Failures 1 6-unit bridges Total, 2 F-8000 1 2-unit bridge 1 2-unit semi- 64 (semirigid) rigid 2 3-unit bridge 1 3-unit bridge 35 2 4-unit bridges Total, 7 32

TABLE XII COMPLETED T''EMPORARY CEMEINTATIONS OF FINISHED RESTORATIONS, ANALYSIS OF FAILURES Restoration One retainer More than one More than one Cement fell out in- One retainer loose retainer loose retainer loose IBM No, of to patient's loose patient examiner patient examiner No. Code Failures mouth discovered discovered discovered discovered 9 B-200 9 4 1 3 1 8 G-400 7 1 1 1 7 G-6oo 4 2 2 6 A10ooo 14 7 1 4 2 5 C-2200 5 2 2 4 E-3500 4 5 1 5 D-5400 0 2 F-8000 2 1 1

TABLE XIII COMPLETED TEMPORARY CEMENTATIONS OF FINISHED RESTORATIONS, DATA AT REMOVAL OF SUCCESSES Cement Noo of Remove Dentin Clean Restoration Clean IBM Code Successes E/D E/D E/D No. 9 B-200 25 25/0 25/0 25/0 8 G-400 28 28/0 28/0 28/0 7 G-600 17 17 17 17 6 A-1000 47 45/2 45/2 47 5 C-2200 26 17/9* 19/7 26 4 E-3500 7 4/3** 5/2 6/1 3 D-5400 2 2/0 2/0 2/0 2 F-8000 5 5/0 5/0 /O *Used in three cases without assignment: One case recemented with A-1000 and two cases recemented with G-400: All three successful and easily removed later, **Used in one case without assignment. 34

TABLE XIV TEMPORARY CEMENTATIONS: OF FINISHED RESTORATIONS STILL IN PLACE.No. of No~ of- No. of Cement Months In Restorations Units Retainers B-200 1 10 7 3 G-400 1 3 2 8 1 4 3 12 A-1000 1 1 1 8 1 3 2 8 2 4 4 12,12 1 12 7 18 C-2200 3 1 3 8,8,6 3 3 6 11,11,20* 1 5 3 12 1 4 2 8 E-3500 1 1 1 8 1 3 2 8 1 4 3 12 F-8000 2 1 2 10,10 *Patient overseas in armed forces

TABLE XV TEMPORARY CEMENTATIONS OF FINISHED RESTORATIONS ANALYSIS OF BRIDGES BY TYPE OF.FIXATION Cement Rigid Semi-Rigid Cantilever B-200 26 1 0 G-400 20 0 0 G-600oo 9 0 0 A-1000 35 2 0 C-2200 17 2 0 E-3500 9 0 0 D-5400 1 0 0 F-8000 3 2 1 36

TABLE XVI FINAL CEMENTATIONS OF FINISHED RESTORATIONS LISTED BY NUMBER OF UNITS IN ASCENDING ORDER; CEMENTS D-5400, F-8000, AND F-9200 No. of No. of Total Units Units/Restoration Restorations Cemented Cemented D-5400 3 1 3 * 8 1 8 Subtotal 2 11 F-8000 1 59 59 2 3 6 3 102 306 4 34 136 5 12 60o 6 7 42 8 4 32 9 1 9 11 1 11 14 1 14 Subtotal 224 675 F-9200 1 2 2 3 8 24 4.1 4 5 3 15 6 2 12 8 1 8 12 1 12 13 1 13 14 1 14 Subtotal 20 104 Totals 246 790 *Cemented during preliminary study and being followed by recall examinations. 37

TABLE XVII FINAL CEMENTATIONS OF FINISHED RESTORATIONS LISTED BY NUMBER OF RETAINERS IN ASCENDING ORDER; CEMENTS D-5400, F-8000, AND F-9200 No. of No. of Total Retainers Cement Retainers/Restoration Restorations Placed Cemented D-5400 2 1 2 * 3 1 3 Subtotal 2 5 F-8000 1 62 62 2 128 256 3 26 78 4 5 20 5 3 15 Subtotal 224 431 F-9200 1 3 3 2 11 22 3 3 9 6 1 6 7 2 14 Subtotal 20 54 Total 246 490 *Cemented furing preliminary study and being followed by recall examination. 38

TABLE XVIII NJUMBER OF SPANS IN EACH BRIDGE No. of Cement Used Spans D-5400 F-8000 F-9200 o 0 59 2 1 1 154 14 2 1 10 1 3 0 1 3 TABLE XIX NUMBER OF PONTICS IN LONGEST SPAN OF BRIDGE No. of Cement Used Pontics D-5400oo F-8000 F-920 o 0 59 2 1 1 126 8 2 0 26 5 3 0 5 0 4 1 8 5 TABLE XX TYPE OF FIXATION No. of Cement Used Type* D-5400oo F-8000ooo F-9200 o 0 58 2 11 2 153 12 2 0 7 0 3 0 2 3 4 0 1 0 5 0 2 3 6 0 1 0 *See page 63 of appendix for key to type. 39

TABLE XXI RETENTION GRADES Cement Used Grade* D-54oo00 F-8oo000 F-9200 2 1 28 4 3 0 48 2 4 0 57 6 5 1 43 4 6 0 4 1 7 0 37 2 8 0 0 0 9 0 7 1 *See page 65 of appendix for key to grade. TABTLE XXII ARCH LOCATION Location Cement Used 1Number* D-54oo00 F8000ooo F-9200 1 0 5 5 2 1 1 1 3 0 0 0 4 0 1 0 5 0 2 0 6 0 52 1 7 0 1 0 8 1 130 13 9 0 32 2 *See page 65 in appendix. 40

TABLE XXIII OCCLUSAL FUNCTION GRADE Cement Used Grade* D-5400 F-8000 F-9200 O 0 17 0 1 1 43 2 2 0 24 1 3 0 1 O 4 0 103 7 5 0 31 3 6 1 5 7 *See page 66 in appendix., TABLE XXIV STUDENT/PATIENT REACTION Cement Used Grade D-5400 F-8000 F-9200 (No Comment) 1 95 4 1 (Liked Cement) 1 109 16 41

TABLE XXV ANALYSIS OF THE NINE BRIDGES WHICH CAME LOOSE Br. Cement Time of Units Retainers Retainers Retainers Type of No. Failure Cemented Failed Holding Restoration 1 D-54oo 7 mo 8 3 1 2 Max. canine to opposite 2nd bicuspid 2 F-8000 7 mo 8 3 1 2 Max. canine to opposite 2nd bicuspid 5 F-8000 6 mo 6 2 1 1 Max. canine to canine 4 F-8ooo 8 mo 5 3 2 1 Mand. posterior, molar to bicuspids 5 F-8000 9 days 3 2 2 0 Mand. posterior 6 F-8000 10 mo 3 2 2 0 Mand. posterior 7 F-8000 91 days 5 2 2 0 Mand. posterior 8 F-8000 6 mo 3 2 1 1 Mand. posterior 9 F-8000 8 mo 5 2 1 1 Mand. posterior Totals 45 21 15 8

TABLE XXVI EXAMINIATIONS OF SUCCESSES Cement F-8000 Cement F-9200 Restoration Type No. of No of Units/Retainers Months After Restorations Months After Restorations Units/Re train ers Re storations Cementation Examined Cementato Examined i/i 2/1,3/2,4/1,4/ 9,6 /17/1, 8/12,9/3,12/1 3/2 1/1,2/i, 3/1, 4/5, 5/7,6/12, 10/i 7/11,8/9,9/75,10/2 4/2 4/, 7/3,8/, 9/i, o /i 4/3 5/1/,6/3,7/2,8/2 5/2 7/i,8/2 5/3 4/1,6/1,7/2,8/i 8/4 4/1,8/1 8/5 6/1 12/6 9/i 13/7 3/i 14/5* 5/i 14/7 i3/i *8-unit, 3-span mandibular fixed bridge holding a symmetrical, distal extension, removable, Chayes attachment restoration, supplying 6-units, 2 molars and 1 bicuspid on each side.

TABLE XXVII NUMBER OF RESTORATIONS AND RETAINERS EXAMINED AT VARYING TIME INTERVALS Months Following No. of Examined No. of Cementation Restorations Retainers 1 1 2~~~~~~~~~~1 2 2 2 3 3 4 11 4 9 20 ~5 18 31 6 i8 42 7 20 43 8 2849 9 8 17 10 4 8 12 1 1 Totals 114 234 44

ALL TEMPORARY RESTORATIONS SINGLE USE DATA S- SUCCESS F-FAILURE 111111 150 140 130 120 110 I LI) z 90 so u 60 Z 50 40 80 60 9% S F S F CE MENT C CE MENT E Graph I Retention of all restoraIons -- single use dat. 54 Graph I Retention of all restorations -- single use datal.

ALL ACRYLIC RESTORATIONS SINGLE USE DATA S- SUCCESS F- FAILURE Il 120 11O W.- 90 z I 80 LL. o50 O LU 40 30 z 20 13% i 11J S F S F C E ME N T C C E ME NT E Graph II Retention of acrylic restorations -- single use data.

ALUMINUM CROWN FORMS SINGLE USE DATA S —- SUCCESS KX F — FAILURE E 120 Ii 110 100 90 Cz 80 U 0 0 30 z 20 7 4% S F S F C E M E N T C CEMENT E Graph III Retention of aluminum crowns -- single use data.

SINGLE USE DATA NO-DID NOT BURN B - B U R N E D B - BURNED IIIIII AN- ANESTHETIZED D 120 1O0 100 90 00 so 70 60' LL I x I 28 % LU co 40 24 o 30 20 10 NO B AN NO B AN C E M E N T C C E M E N T E Graph IV Burn or no burn -- single use data. 48

APPENDIX METHODS OF DATA COLLECTION Objective 1-Temporary Cementation of Temporary Restorations Two forms were used to collect data in this portion of the study. The first was a data sheet, labelled in upper left corner 8/65 C&E, Fig. 2. One data sheet was used for each. patient-operator combination. These data sheets were personally completed by the investigator obtaining the information from the patient and/or student operator. Most items are self-explanatory on this data sheet, however, section 9 and 10 require some comment. Section.-=The retentive qualities of each preparation were assessed at the chairside by the investigator on the following characteristics: long or short (ioe., occluso-gingivally), parallel or tapered (ioe., with relation to axial walls), presence or absence of boxes, grooves or pins. Positive retention characteristics were recorded as checks above the horizontal line while negative retention characteristics were recorded below the line, The appropriate boxes were checked for each preparation. Four grades of retention were recognized: Grade A, all scores in upper boxes; Grade B, two scores in upper boxes; Grade C, one score in upper boxes; Grade D, no scores in upper boxes. Section lO — This section is divided into two halves, one labelled C for cement C-2200 and one labelled E for cement E-3500. The dates of cementation and which teeth were randomly selected for the single use data collection were notated in these sections. The second form used was a work sheet, labelled in upper left corner 8/65(2) Conto CE (Fig. 3). The purpose of this work sheet was for ease of checking off factors at cementation and removal and also indicating the days the cementation was successful or how long the cementation was successful before failure. Each wide horizontal line served as the identification of a single patientoperator combination. The first columns indicated the data sheet number to which this series of entries referred. The second column gave case assignment date, column 3 indicated the instructor on the case, column 4 the student's name and column 5 the patient's registration number. Proceeding to the right and commencing with column 6 the wide horizontal line was divided horizontally for dichotomous data scoring. Information for cement C-200 was scored on the upper line and for cement E-5500 on the lower. Column 6 labelled these lines. 49

Two main headings at the top of sections to the right of column 6 contained information regarding operator and patient reactions at cementation and at removal of the temporary restorations. The former contained four double columns and one single block. Each of the four double columns required a check mark in one or the other of the two horizontal spaces in each. These were labelled in abbreviated form as follows: Mix E.D. This referred to ease-E or difficulty-D of mixing the powder and liquid. Wk.T. In Ad:ad Working time comments were scored here. In Ad-adequate or ad-inadequate working time to get the temporary restorations filled and seated to place. Xcs rem E.D Removal of excess cement E-easy or D-difficult Ts'te No Here the unsolicited comments from the patient were scored. Bn:bn No Bn-patient complained of burning. bn-patient did not voluntarily comment about burning sensation during cementation. The block labelled "sheet fill-in" was for the investigator's convenience to assure completion of the data sheet (Fig. 2); i.e., a check on himself. Five likewise double columns appear in the At Removals section to the right. Their abbreviated headings indicated as follows: Stayed days In:Out Arabic numerals were entered in one or the other of these columns. If the temporary cementation had been successful, the number of days it had succeeded were entered in the "In" space. If the cementation had failed, the number of days prior to failure were entered in the "Out" space. Proceeding to the right, the next three double entry columns were used to indicate either E-, easy or D-, difficulty in (1) removal of the temporarily cemented temporary restorations (Tke off); (2) cleansing of dentin of the preparation, (Den Cln); and (3) cleaning the restoration for re-use if necessary (Apl Cln). The last double column indicated color change acrylic temporary restorations, either Ys-yes color change occurred or No-color change did not Occur. 5o

Objectives 2 and 3-Temporary and Final Cementation of Finished Restorations One additional data sheet (Fig. 5), was used for the collection of information concerning both objective no. 2, the temporary cementation of finished restorations and objective no. 3, the final cementation of finished restorations. The investigator personally filled out this data sheet using the following directions as a guide. 1. Two series of chronologic numberings of data sheets were used: series 5000's for final cementations and series 3000's for temporary cementations of finished restorative dentistry: crowns, bridges and attachment-removable restorations. 2- 7 o Sel f-explanatory. 8~ Space for cross-indexing of model boxes o 9. and 10. Self-explanatory, except that 10 was a record of unsolicited comment by patient. 11. The numbering of all teeth was standard clinic procedure as if facing the patient. Immediately adjoining the thirty- two, numbered 3/8" x 3/8", above teeth 1 through 16, and below teeth 17 through 32, are six divided spaces, three above the horizontal line and three below it. Their purpose was to provide labelled spaces for the observer to use check marks regarding his evaluation of the retention of the cavity preparation of the abutment of this particular tooth. He checked the space either above the line or below it in all three spaces, for each prepared abutment, the key for use of which is as follows: L - Longg P-Parallel A - Ample cavo-surface for cement available S - Short T- Tapered M - Minimal cavo-surface for cement available Thus, diametrically opposed observations of the three situations was forced. The use of this data for retention scoring will be treated later in 12. Ao Use of the 3/8" x 3/8' squares 1. If that tooth (teeth) were missing and were prosthetic members (Not abutments) (a) Upper portion of square nearest the abutment was used to indicate the type of union with that abutment. Letters were used for this, keyed thus: S-AoSoldered union, or rigid fixation to abutment or pontic L-Loose joint, or semi-rigid union with abutment or pontic 51

A-Atta.chment, remorable (Chayes-type) union with abutment or pontico (b) Indications of fractional space(s) of pontic(es) due to "drifting" of teeth, if having occurred, was noted in this (these) space(s). Thus reduced span lengths were apparent. Arabic numeral.s for pontic mesio-distal length were used: 6-1/2 incisor or bicuspid; 7-bicuspid or incisor or 1./2 molar; 8-molar length. (c) Other observer comments regarding unusa1. conditions encountered. regarding the restora-tion were written in othe:r, unused squa.res, on the arch opposing the one on which the restoration was being chartedo (2) If the tooth had been prepared as an abutment for the restoration: (a.) lUpper left corner received the appropriate Roman numera.l, indicating the type of prepa.ra.tion cut on the abutment, the key for which follows: I Complete coverage restorationo Add letter J. Vc, or P to indicate Jacket, Veneer Crown, or Post Crown respectively, otherwise a. cast crown is inferredo II. Protected cur 3 o/4 crowno If cusp 3/4 crown. If cusp protection was not used, the investigator circled the Roma.n numera.i III. Protected cusp MOD restoration. If cusp protection wa.s not used, he circled the numeral. IV. Pinledge (-lay) restoration. If cusp protection was not used, he circled the numeralo \T Two surfa.ce ini.ay (b) Lower left corner received the appropriate Arabic numeral, indicating the number of any intra-coronal. pins in the preparation. (c) Entire right half of the square wa.s used to indicate the location of any pins used in the preparation. Ea.ch pin' s location shown by a two digit Arabic numera.il, the key for whose use wa.s as follows: 52

1 —Mesial 4-Lingual (palatal) 2-Distal 5-Occlusal (incisal) 3 —Buccal (labial) 6-Cervical Thus a two dimensional location of each pin was achievedo The first digit of the numeral was used for positions 1, 2, 3, and 4, while the second digit was used for positions 4, 5 and 6. 12o Each abutment tooth's retentive grade-was arrived at thus: three checks above horizontal line gave "An grade, ie, Long, parallel preparation with abundant surface of cement between preparation and metal and/or procelain; two above'TB"T that is9 any two with one below. Only one above gave "C", and all three below gave "D'". In this latters a short, tapered abutment with minimal surface available for cement was the siutation. Further discussions of the treatment of these grades in a numerical coding follows later,, page 61 at B, through B(L). 13. This same above principle applied in the grading of the occlusion, or occlusal demands on the restoration, the key for use of which boxes follows. Numerical coding of these grades appears later, page 66. HL Holds Least NG No guidance NX No signs of bruxism HM Holds most DG Does guide BX Has signs of bruxism 140 and 15, Are blank spaces for the grading of auxiliary situations, Later these were found superfluous and were unused. The horizontal lines occupying the lower portion of the data sheet were used to date and record information on recall examination. Data Transfer to IBM Cards Standard, 80 column, 30 line IBM sheets were used to score each Individual cementation. Thus, each piece of restorative dentistry cemented required a card. The directions for use of these columns appear in the appendix pages 60-67. 53

ZINC OXIDE-EUGENOL CEWENTS (Directions for 8/65 data sheet) 1. Two series of chronologic numberings of data sheets will be used: series 5000s for final, cementations and series 3000's for temporary cementations of finished restorative dentistry: crowns, bridges and attachment-removable restorations 2, 7 Sel f exp.La.na.t ory. 8., Space for cross-indexing of model boxes. 9. and 1.0. Sel.f explanatory, except that 10 is record of unsolicited comment by patient ilo The numbering of all'teet~h is standard clinci procedure. Immediately adjoining the thirty two, numbered 3/`:' x 3/8" squares, above teeth 1 through 16, and below teeth 17 through 32, are six divided spaces, three above the horizontal line and three below it. Their purpose is to provide labelled spaces for the observer to use check marks:regarding his evaluation of the retention of the cavity preparation of the abutment on this particular tooth, He checks the space either above the line or below it in all three spa.ces, for each prepared abutment, the key for use of'which is as follows: LWLong P —Parallel A-Ample cavo-surfac. for cement available S -Short T=Tapered M-Minimarl. cavo-surfa.e for cement available Thus, diamet:rically opposed observations of the three situations is forced. The use of this data for retention scoring wiLlT be treated later in 12. A. Use of the 3/8" x 3/8' squares lo (If that tooth (teeth) are missing and are prosthetic members (not abutments ): (a.) Upper portion of square nearest the abutment is used to indicate the type of union with that abutmento Letters are used for this, keyed thus: S —Soldered union, or rigid fixation to abutment L~Loose j oint, or semi-rigid union with abutment A~Attachment, removable (Chayes-type) union with abutment

(b) Indications of fractional space(s) of pontic(es) due to "drifting" of teeth, if having occurred, is noted in this (these) space(s). Thus reduced span lengths will be apparent. (c) Other observer comments regarding unusual conditions encountered regarding the restoration a.re to be written in other, unused squares, on the a.rch opposing the on which the restoration is being charted. (d) Wavy line indicates span of fixed replacement(s). Double wavy lines indicates removable portion(s) of attachment restorationso 2. If that tooth ha.s been prepared. as an abutment for the restoration: (a) Upper left corner receives the appropriate Roman numeral, indicating the type of preparation cut on the abutment, the key for which follows: I. Complete covera restora.tion Add letter J, Vc, or P to indicate Jacket, Veneer Crown or Post Crown respectively, otherwise a cast crown is inferred. II. Protected cusp /4 crown. If cusp protection is not used, circle the Roman numeral. IIIo Protected cusp MOD restoration. If cusp protection is not used, circle the numeral. IVo Pin-ledge(-lay) restoration. (b) Lower left corner receives the appropriate Arabic numeral, indicating the number of any intra-coronal pins in *the preparationo (c) Entire right half of the square is used to indicate the location of any pins used in the preparation. Each pin's location shown by a two digit Arabic numeral, the key for whose use is as follows: 1 - Mesial 4 Lingual (palatal) 2 - Distal 5 Occlusal (incisal) 5 - Bucca.l (labial) 6 Cervical Thus a. two dimensional location of ea.ch pin is acheived. The first digit of the numeral is used for positions 1, 2, 3 and 4, while the second digit is used for positions 4, 5 and 6. (See examples and their description antta.ched ) 55

12. Each abutment tooth s retentive grade is arrived at thus: Three checks above horizontal line gives "A" grade, i.e., Long, parallel prepartion with abundant surface of cement between preparation and metal and/or procelain; two above "B", that is, any two with one below. Only one above gives "C", and all three below gives "D'" In this la.tter, a, short, tapered abutment with minimal surface available fore cement is the situationo 13. This same above principle a.pplies in the grading of the occlusion, or occ.lusa.l dema.nds of the restoration, the key for t-he use of which boxes follows, likewise yielding A, B, C, and D situations, a.s above described. HL Holds Lea.st NG No guidance NX No signs of bruxism HM Holds most DG Does guide BX Has signs of bruxism 14. and 15o Are bla.nk spaces for the grading of auxiliary situations later to'be describedo

6I,..& \ ZINC OXIDE - EUGENOL CEMENTS 8/65 1) Sheet number 3JZ/ 2 2) Rest'n: Single Fixed bridge 3 Att'ch'm'nt rem'v'ble (No.) (No. units) (Number of units) 3) Cement code W-/O 4) Chair number 53j 5) Pat'n's regis. No. y 3 Z 6) Date cemented / / 7)Graded by -Ir 8) Model number //o<G 9/2 14 /L 9 " 19 9) Working time:' / 10) Taste: Adequate / Inadequate Did NOT burn Did BURN 11) R ESTORAT I O N C H A R T LPAI LPII P A LI P L PIA tL P 1ALIP LP P A L PAP P P;A 2.I. I, 9,8, I *-. M-S TM iM-fT 1 MS! MiS TIM StT /S T!M SiT Mi SITtM S T/M ST MS T M S T MIS T!M S T!MS!T 32 31 "30 9 28 7 26 25 23 22 21 20 19 18 17 P 1 IL IP AiL IP L L? A LP A L PAL PA 1LP P.A L LIP AL 1 P LIALPAL|P A L IP I IAPAL f 1j L I: m ~~' SIT M S T M SrT;/~~ T I STLlS T prit ltS ltMs||s M: T 12) Retention 13) Occlusion,- 14) 15) Gr ade Grade' D Grade Grade_ HM&DG BL Da't F I N D I N G S This example is of the charting of a temporary cementation of a finished, rigid fixed bridge supplying missing tooth #28 with the use of a Trupontic. Both ends are soldered, a veneer crown on #27, whose retentive grade is "B", the pontic and a protected cusp 3/4 crown, having.mesial and distal cervical pins, on tooth #29, whose retentive grade is "A". The minor dis-similarity of the preparations' retentive grades dictates a "3" grade for the restoration. Occlusal demands dictate a "5" grade since, while little of the occlusion is held or borne, it is guided and evidence of bruxism is present... _.. - -. - - 57

d~e sg9Fe I ZINC OXIDE - EUGENOL CEMENTS 8/65 1) Sheet number to %~ 2) Rest'n: Single Fixed bridge,/ Att'ch'm'nt rem'v'ble (No.) (No. units) _ (Number of units) 3) Cement code 4) Chair number 5) Pat'n's regis. No. 6) Date cemente 7)Graded by 8) Model number /w 8 9) Working time: 10) Taste: Adequate 1 Inadequate Did NOT burn / Did BURN 11) R E S T O R A T I ON C H A R T IL L~~~rS~ t P ~ $ lL. L P L. i rp e't IAP. LIXlP —-~ AL[PA, L.P A[L.PA LP]ALPA.LIP1, L I I'IIP[LIPIAAL''-T'4''IP " PIPTIM SM1 T I I I II-Ihi I M T1 M T S f T M T I T MTM T X E S, Y. 2 3.. l 11 12 13 14 15 16 P.L LPA1L PAL LP A LBP L P LA L P L L P A I P A LI P | IPPIL IA LAL1 P L IA Ij L P IA 11 L P s j TST SIMs t TST MSIT 1A S I 1 S T T MSTSCM Ls T IVI S T MST M T STM ST M 12) Retention; 13) Occlusion H NG 14) 15) Grade Grade _ Grade Grade D)at__!F I N D I N G S Here the final cementation of a semi-rigid fixation of two flat-back-facing pontics has been done replacing missing teeth numbers 9 and 10. These pontios have been soldered to a 3/4 crown on the left cuspid while the other end of the bridge is supported by a semi-rigid conneotor into a recess in a pinledge retainer on tooth number 8. This pinledge preparation had two pins, located at the distalincisal and lingual-cervical, a box having been cut in the mesial to allow room for the semi-rigid recess. Retentive grades for both retainers is "B" giving a "4"1 grade for the restoration. While tooth #8 is short, it has good parallelism and ample surface for cement. Tooth -tf11 is long although tapered and ample surface of cement was available. The examiner might not have graded this as,mle however, had not the placement of the palatal-cervical pin been done. Occlusion grade is'211 since less than half of the occlusion is held, but ff11 guides. Favorably, no signs of bruxism appeared. 58

I r~1w t- ZINC OXIDE - EUGENOL CEMENTS 8/65 1) Sheet number 39 2) Rest'n: Single Fixed bridge t Att'ch'm'nt rem'v'ble 3 __ _ (No.) (No. units) (Number of units) 3) Cement code; 4) Chair number /7s 5) Patt'n's regis. No. 3 7 6_ 6) Date cemented 7)Graded by 8) Model numbeis tjs /J 1 /_ 5__19_~ 9 &a4',, 7. r 9) Working time: 10) Taste: Adequate V Inadequate Did NOT burn / Did BURN 11) RES T O R A T I O N C H A R T TITA L P AL P A L P A LI P A LPA L P ALPA PLIA P P L P A L P L4-PI.L' P L P.;LP| ls TiMSl TMIS T MiS T M S TM ST TIMS TM S T M I i 1 1 - 3- 4 5 6 7. 1 ~9 10 1I 12 13 14 15.16 AC,, _ d _ _ _...2 3. 30 29 28 27 267257 2. 23 22 21 20 19 2?]L~LL1LPA!LIP ALPIA ~L P A LPA LLP A AL P L 3. A L P!A L P L I'L LILII1~I I IP PIP; A LI 2 S.TT Mi T M 1 Ts T ITriTM MST IMST nT M Y'P 1 S | M | 1 1 1.MSt T M I MT T 12) Retention' 13) Occlusion 3 L NGNX 14) 15) Grade Grade Grd e Grade Grade Date F I N D I N G S ~~:/aL,/at~r. ck< ~ ~/s,~ e<^z s/,~A~; /, ~ -,,~ zJ:3~ The temporary cementation of a complicated fixed and removable combination is here shown, all teeth missing on the mandible except the two canines. They each have been veneered to support a rigid fixation replacing the incisors and the two 1st bicuspids with distal cantilevers from the central span. Attachments have been placed in these two cantilevered pontices, replacing missing teeth #28 and 29, on their distals, to accommodate also a bilateral, extension, attachiment-removable prosthesis, supplying teeth numbers 18, 19, 20, 29, 30 and 31. Grading of the retention and occlusion is as has been described in previous examples. _ 59

2-7/66 I.BoM. FORMAT I GEERA S TATEMEN Cards will be punched at the following stages: 1. Temporary cementation of finished restoration (on (one ard); TF Active 20 After removal of temporary cementations (one card); TF Complete 3. Final cementation of finished restoration (one card); FF Active 4o Recall of cemented restorations (one c4rd); TF and/or UF Active 50 Failure of cementation noticed by patient (one card); TF and/or FF? Coplete IIo RUIES FOR SHEET SCORING 1 Unless numerically significant, zero numeral indicates no entry or information insignificant, except in Sec. M and in follow-up examinations, Sec. X9 q.v. 20 Using multiple column spaces for entries, when fewer digits than supplied are needed, as in numerical numbering or dates, units sprace is on right and, proceeding to left, es, hundred3 and thousands spaces are usedo Note: Zero numeral use is often required. ~ixample:. 3 in three column space is 003; NOT 030 or 300 5 in two column space is 05; NOT 50, etc. 30 ALL 56 columns are required in the original punching for each restorationm 4, Single column grades 1 thru 9 generally follow the pattern indicated below; Ao The lower the number the better or more favorable the situation. The hi aer the number the worse or less favorable. Exkam-ples (1I) Section H, cols 2 2 Highest psi gets 01 Lowest psi gets 09 60

2-7/66 (2) Section QR, colo 35, student and/or patient reactions, if expressed. B. Significance of even and odd numerals in sections N and X Four grades have been assigned the retention of individual retainers. Since experience has shown that weakly retentive retainer(s) soldered to strongly retentive retainer(s) invites failure of the cement bond on the weaker, identification of this situation and the relative retention of the restoration can be shown in column 32, (1) belowo In extremely dis-similarly rvs moderately dis-similarly retentive grades, the examiner adjusts the odd grade subjectively from practical experience. To separate the findings for a single abutment retainer on the restoration versus findings for more than one abutment retainer, the even and odd principle is used in section X, column 60, (2) below: (1) Retention grade, col. 32 (section N) (a) Even indicates relative acceptable similarity between or among abutment retainers' retention 2, best thru 8, worst; (b) Odd indicates relative dis-similarity between or among abutment retainers, 3 best thrEa 9 worst. 1NOTE: Singles get odd numerals 3, 5, 7, 9. (2) Follow-up findings, colso 59, 60 et al following (Section "X (a) Even indicates findings on more than one abutment retainers of bridge/splinte (b) Odd indicates findings on on ne abutment of multiple abutment bridge/splinto Also sinles. (a) 30, 50, 70 indicate best for whole restoration. (b) 19, 39, 79 indicate worst for whole restoration. 61

Section Used I...Number P U R P 0 S E A 2 1,2 Institution or operator IoDo by company; University of Michigan 01 B 1.3 Examiner I.D.; University of Michigan: Dr0 Mers 1, T. Gilson 2 C 6 4,56 Patient I. D.; University of Michigan: Patient 7,8,9 registration number, if registered. The 4 column, usually containing 0, is used for bizarre situations as follows; digits 90000n and 50000n (n indicating numerical number o' cases in these categ.;ries) 9 - indicates patipnts with no registration number, i.e. Dr.o Myers himself et al, from whom -data cSld be collected~ 8 - indicates Dental School personnel, whose registration number contains capital letter D follo'7ing the registration number. 7- indicates construction and cementation by a Restorative Dentistry Graduate Student. 6 - indicates a recementation of a Temporary Cementation, either a failure or a removal of a successful cementation; also re-cementation by final cementation. 5 - indicates use of Fixable-Removable attachments by the Ash-Scott micro-transmitter research project. D S a lo,,10,11 University of Michigan student IDo; 10, 11,9 12 chair 12 number _ 13,14 13, 14 digits of his year of graduation E 2 15916 University of Michigan instructor I D.: 01 Dro Myers 10 Parti al Dent~ure Depto 02 Dr Faust 1l Dr. Russell Anderson 03 Dr0 Segat 12 Perioo Grad. Students' 04 Dr Lorey reconstruction 05 Dr Maly 13 Dr. T. Gilson 06 Dr. Schaffer 14 Op. Dept. insterution 07 Dro Miller 15 Dr. Clayton 08 Dr. Johnson 09 Dr. Fusilier F 5 17,18, Date of cementatLCiono Numerical nmber of day of yeSr. 19 20, 21 Year of the century G 1 T22 Operation I. D. 1 Final cementation; 2 -Tempo-ay, _I_____ 1 1| cementat ion H 2 23,24 Cement used: o01 F 9200 99 Po$sible 02 F 8000 03 D 5000' 04 E 3000 05 C 2200 06 A 1000 07 G 600 08 G 400 09 B 200 I-'2- _25f 26. Numerical number of'units of re'toration 01 thru 16 62

Columnrs Column Section Used Number P U R P 0 S E J: 2 27,28 Numerical number of abutment retainers cemented 1 thru 16 I i 1 29 Numerical number of spans (separate edentulous areas replaced by the restoration) 0 thru 9 L 1 Number of units of pontics in longest span M 1 31 Type of fixation: 0 Single retainer restoration 1 Rigid restoration of one retainer or more with pontic(es) 2 Semi-rigid restoration 3 Cantilever restoration 4 Removable attachment restoration 5 Fixable-removable att. 1 32 Retention grade (see explanation p. 6) 0 1 1 3 1 Arch location index Tsee explEaation p. 6) _ P- q 1 - 34 f Occlusal function grade (see explanation p. 7) aa 1 3 R 35 Student and/or patient reactions 0 No conmment if expressed: 1 Likes 2 Dislikes 3 Resents study -S. 2.36,:37 - cement expected to retain restoration (TFs) only 1. oraI cementation of finished dentistry, Compalete. T 2 1 38,39 Months cement expected to retain restoration (=Ts) I_______ I only Temporary cementation of finished dentistry, Cor te S1T 4F 3637 y Temporary cementations of finished dentisty Active (i<e. 38,39 still in the mouth for long periods) have data sheets and punch-cards nmbered in these columns thus, 3001, 3002 etcD o Final cementations of finished dentistry (FFs), i.e. those cases being periodically examined have dats sheets and punch-cards numbered in these columns thus, 0001, 00029! I I etcO U 1 ArchF w II.: t MaiiiLyary 2 Plandibular V 16. 1 th'ru Indivdual tooth IoDo 4 — "" Rght third molar t-h- -8 Right | 56 B c,4central incisor; 49 Left central.ncisor thru 56 Left third molar (see explanation po 8). w 2 1 558 Number of days following cementation that exemination of I restoration's condition is done X 2 59,60 Follow-up findings: 59 column 1 Patient discovered 3 Examiner finding in temporary cementations expected to remain in place 5 Ditto for Finale cementations 7 Findings at removal of Temporary J I 1 3cementations which are successful 63

2-7/66 Columns Column S=ction Used Number P U R P 0 S E X 2 59,60 Follow-up findings (continued) Examples s 59 60 columns 30 50 All firm, margins, tight; success 31 51 Examiner suspicious of retainer 32 52 Examiner suspicious of retainers 13 33 53 Retainer tight, marginal leaks 14 34 54 Marginal leaks, plural retainers 15 35 55 Retainer loose (no caries) 16 36 56 Retainers loose (no caries) 17 37 57 Retainer loose, caries beneath 18 38 58 Retainers loose, caries beneath 19 39 59 Restoration dislodged from abutments into mouth 70 Removes easily, cleans easily 71 Removes easily, abutment cleans hard 72 Removes easily, abutments clean hard 73 One retainer off hard, easy clean 74 Plural retainers off hard, easy clean 75 One retainer off hard, clieans hard 76 Plural retainers off hard, clean hard 77 One'retainer impossible removal 78 Plural retainers impossible removal 79 Remake of appliance due to ruin in removal attempts Y 2 61,62 Number of mlonths following cementation that examination findings are recorded {Z 2 9 63 64 Findings as done coluns 59, 60 Yz 4 65ze68 }Ditto Y,. Z YZ 4 69-72 Ditto Y Z.._, I. Ditt YZ5 1 4 77-80 Ditto second card to be carried on using 4 column format follow-up allows for five ex.aminations recording commencing with Section Yo 64

2-7/66 Explanatory Notes Similar Dis-similar N 1 31 Retenth grade Use odd numeral if dis-sinilarity among or between abutments retention o Use even numeral if similarity is close 4 5 among abutment retention. L %P AIt or L A or LP Key eaS T M S T M S M L Long S Short 6 P Parallel T Tapered A Ample orLII M Ainimal # FA r or or P j i Surface for 5T_____ cement to bond restoration 8 9 LIP A O0 1 33 Arch location index. 1 Bilateral bridge/splint, posterior to posterior 2 Bilateral bridge/splint, posterior to canine 3 Bilateral bridge/splint, posterior to lateral 4 Bilateral bridge/splint, posterior to central 5 Unilateral bridge/splint, posterior to central 6 Anterior bridge/splint, c-aine to canine either lmdilateral cliine to incisor or bilateral incisor to incisor single incisor restoration 7 Unilateral bridge/splint, posterior to lateral 8 Unilateral bridge/splint, posterior to posterior ((no canine involved) single posterior restoration 9 Unilateral bridge/splint, canine to posterior sinagle cuaine restoration 65

2-7/66 P 1 34 Grade of occlusal function ~~K e1~~ wH NG NX Key 1 I ri-inEl HL restoration holds least of occlusion IM restoration holds most of occlusion x x 2 HL NG NX NG no occlusal u by M DG BX restoration x DG restoration does de the occlusion lX no clinical evidence of 3 [L ZNOEX afunetional attrition (bruxism) | IM DGBX BX bruxism evident clinically _ r 4 _ 4 HiL NG NX 6 I!a.HLINGINX gs_ x x x 66

2-7/66,mlenato Notes V 16 41 thru 1 Complete coverage restoration 56 2 Protected Cusp 3/4 cromwn 3 Protected Cusp MOD 4 Pinlayr'5 Two surface inlay 6 1/2 bicuspid/incisor size pontic 7 Whole bicuspid/incisor size pontic(1/2 molar) 8 Molar size pontic 9' Non-hooded cusp in occlusion inviting push-out by occlusal force 67

ZINC OXIDE-EUGENOL CEMENTS "C" -and "E" TEMPORARY CEMENTATION OF TEMPORARY DENTISTRY TO: Mr. FROM: Department of Crown and Bridge Prosthesis Assignment was made on, 196, of a patient, registration number, for crown or'bridge prosthesis with your instructor, Dr.. 1. After the preparation(s) have been checked by your instructor, please cement the temporary restorations at least once with temporary cement "C" and once with temporary cement "E", noting the date and which cement was used on the Treatment Record. If pin-holes have been prepared, grease the pin-holes only with vaseline prior to temporary cementation. 2. The cement powders are located in individually labeled drawers in a dental cabinet outside the south-east corner of the "cage". Take one vial for each temporary restoration to be cemented. Please remove a dropperbottle of liquid from.the top rear compartment of this cabinet to keep in your cubicle thereafter. Always replace the cap on the nozzle of the dropper after use. 3. On one end of a parchment-paper slab, sharply tap out entire contents of particular powder vial(s) to be used. Remove small cap from the dropper nozzle, up-end the liquid bottle vertically and, squeezing the white soft polyethylene section, carefully dispense thirteen (13) drops per vial of the powder and mix as follows: 4. Using a heavy spatula, incorporate all of the powder and liquid together at once, applying pressure, thus forcing complete wetting of the powder before spatulation is commenced. Complete the mix in 30 to 45 seconds (approx.). Quickly fill the restoration(s) and place on tooth (teeth). 5. Please furnish either rubber base impression or working model and opposing model to investigator if available at final cementation. Figure 1. Directions to students, cements C-2200 and E-3500. 68

8/65 ZINC OXIDE-EUGENOL C & E CEMENTS 1) Sheet number 2) Student 3) Date assigned 4) Reg'n number 5) Rest'n: Single Joined Temp. bridge (No.) (No.) (No. units ) 6) Material of rest'n. (use checks) Al. cr. ~m, Formed acr. Paint-in acr. Other (write description) A B I rT M E N T S P R E P A R E D 7) T'th No. j | (sn'i 1 2 3 4 5 6 8) Prep'n. (use nmrl) 9) Ret'n. Lg. P1. Gv. Lg. P1. Gv. P1.. Lg.. G. Lg. P1. Gv. g. PI.Gv. Lg. Gv. Lg. P1. Gv Sh. Tp. No. Sh. Tp. No:. Sh Tp. No. Sh. Tp. o. J Sh. Tp. No. grade CEiINT TC C. r C'EMENT "Et' 10) Comments at cem'tn. 11) Comments at removal 12) Investigator's comments Final cementation sheet number Figure 2. Data sheet, temporary restorations 69

8/65_(2) Cont ~ CE ZnO-Eug. Cements - W fOPRI SHEET, temporary dentistry AT CEMENTATIONS AT REMOVALS Sheet As't 1. Student Registra. I x Wk.T Xcs i Tstef Sheet'Stayed TIkel Denf Api jAar....__....DAd'adbnin In, ED D E:1+ Ep Ys _ " i:' E I —:- ^-HI:...., I____ I___ I 1'0-.t~i —t —.-; rE ~ F -,1 C:::,, C _: _-';'' t~i —'- I'- - 1 "P' — -; —-- -L — i ___I _=E 1_ t E _______ — "+"-.- --- -4 — I I _-_-'- -, -;- - -- -,-,.-.i - _ _ _] ~~~~_ E T |........,., ~_ _, ~ _ 1.''.. C E 7 7 _ A. - -e. -E V _ _:......... ____! 1:,' ~,Vt> E-' - - - - - C.... -:..... v — IT-::;! i:.. i'E' -- ~ [ I.................. [..... I..... i:' i1 i i i i { i: I: FigureI ~. Woksee-tmprr retrios

ZINC OXIDE-EUGENOL CEMENTS Cementation of Finished Restorations I. TEMPORARY CEMENTATION BY SPECIAL ASSIGNMENT 1. If assignment of any of the following is made: "A" 1000 These are supplied in two-tube combinations "B" 200 of pastes, one being the base and the other "G" 400 the catalyst. Take a parchment-paper slab to the cabinet outside the south-east corner of the cage. Using a freshly exposed top sheet of the slab, extrude equal lengths of each component of the assigned cement, using roughly 3/4 inch of each for each retainer to be cemented. Spatulate the components together thoroughly for 30 to 45 seconds. Fill the restorations with cement and place on teeth. If pin-holes are present, lubricate them with vaseline prior to cementation. 2. If assignment of the following cement is made: "G" 600 Dispense pastes from "G" tubes using the following proportions: 1 inch Component C 1 1/2 inch Component B 3. If assignment of "C" cement is made, follow instructions for Temporary Cementation of Temporary Dentistry, 1/66 TT. Remember the working time with this cement is only 2 1/2 to 3 1/2 minutes AND to grease pin-holes with vaseline if pins are part of a retainer. II. FINAL CEMENTATION BY SPECIAL ASSIGNMENT ONLY FF 1. Cement "F" 8000 will be assigned in special instances when the patient is available for periodic, follow-up examination through August 1967. 2. Alter procedures for powder-liquid combinations previously described only as follows, working time being 5 to 7 minuts: Use one vial of powder to sixteen (16) drops of liquid for each retainer to be cemented. 3. Proceed as per instructions for other powder-liquid cements described on 1/66 TT, however, DO NOT GREASE PIN-HOLES. Figure 4. Directions to students, temporary and final cementations of restorations. 71

ZINC OXIDE - EUGENOL CEIVIENTS 1) Sheet number 2) Rest'n: Single Fixed bridge Att'ch'm'nt rem'v'ble (No.) (No. units) (Number of units) 3) Cement code 4) Chair number 5) Pat'n's regis. No. 6) Date cemented 7)Graded by 8) Model number,19 9) Working time: 10) Taste: Adequate Inadequate Did NOT burn Did BURN _ 11) R E S T O R A T I O N C HAR T LP A IL PIA' L PtA LI PIAA L IP IA ILtPI A L P A LIP Al I L P IP LP1I L P AIL LI P LPIPi pIP.$A- iTI M S I ST IT MM STMtSITIMMi T ST IT, S This S jT M ST T T T MIS T IT|M SMS I'T'-l"1 2' I 5 6 7 8 9 10 11 12 13 14 1 15 — 16 32 31 30 f29 28 j 27 26 T 25 1 4 23 22 21 20 19 18 1 1 17 DateL L A PA 1EL | P A P1F A L P, LI[P L1A L| Pi L| P P A! LPL SP rI~IslrTfM LSTMT M S T M SIT: IAFT M 7TTMIS.TM S T M; S T M S TIM MS S TMS iT MSAT 12) Retention 13) Occlusion fNGf 14) 15) Grade Grade _DG_ B Grade Grade Date F I N D I N G S Figure 5. Data sheet for temporary and final cementations. 72

UNIVERSITY OF MICHIGAN 1111111 1111111 03483 1111 111829111 3 9015 03483 1829