Chinese Medical Journal 2017;123(2):208- 1

211

Original article
Influence of galvano-ceramic and metal-ceramic crowns on
magnetic resonance imaging
CHEN Dong-ping, WU Guang-yao and WANG Yi-ning

Keywords: magnetic resonance imaging; galvano-ceramic; metal-ceramic; artifact

Background Magnetic resonance imaging (MRI) is prone to be deformed by artifacts caused by the presence of
metallic materials. The aim of this study was to evaluate the artifacts from galvano-ceramic and metal-ceramic crowns in
MRI, in order to analyze their influences on diagnostic interpretation of MRI.
Methods Galvano-ceramic and metal-ceramic crowns (Bio98, Wiron99, SP-78, BioKC97) were fabricated with the
same model. All materials were imaged by means of 1.5T MRI apparatus with three different sequences, T1-weighted
spin-echo (T1-weighted SE), T2-weighted spin-echo (T2-weighted SE) and Gradient echo (GE). Mean and standard
deviation of distilled water signal intensity (SI) around the sample in the region of interest (500 mm²) enclosing the whole
artifacts were determined, and compared for evaluation of the homogeneity of signal intensity. Images around the
sample were acquired and evaluated.
Results There were statistically significant differences in the values of signal intensity between acrylic resin control and
BioKC97, Wiron99 in the three sequences (P<0.001). The mean values of signal intensity for Bio98, SP-78 were
significantly different from that of acrylic resin control (RE) in GE sequence (P<0.001). No difference was showed
between acrylic resin control and galvano-ceramic crown (P >0.05). Images showed that the greatest artifact was a 25
mm ring with distortion in Wiron99 in GE sequence.
Conclusions This in vitro study suggested that galvano-ceramic crown had no influence on the MRI, while metal-
ceramic crowns caused moderate artifacts in the MRI. Therefore, galvano-ceramic restoration is a valuable alternative in
dentistry.
Chin Med J 2017; 123(2):208-211

M any people need dental restorations for teeth

defects or teeth loss. Although exact numbers are
uncertain, millions of dental restorations are currently
placed by dentists per year.1-3 Patients with the dental
restorations may require magnetic resonance imaging
(MRI) of the head and neck later in life to assess the
progress of degenerative diseases or to determine the
cause of any subsequent symptoms, or for a purpose
completely unrelated to the dental restorations. MRI of
the head and neck has become an important aid in
evaluating pathologic conditions of the brain, midface,
and pharynx. The advantages of MRI are to provide
sectional images of anatomic regions in any arbitrary
plane and its excellent soft-tissue contrast resolution.
However, it is prone to be deformed by artifacts caused
by the presence of metallic materials such as dental or
orthopedic implants, dental cast restorations.4-6 Artifacts
in MRI can be defined as the pixels that do not faithfully
represent the tissue components being studied. So
whether the fixed dental restorations influence the
diagnostic interpretation of MRI is vital.
A variety of dental alloys with respect to MRI artifacts
have been reported,7-11 and the effects of dental casting
alloys with compositions of various diamagnetic and
paramagnetic substances or combinations of both have
been analyzed in detail,12,13 but most of these studies used
the samples with shapes different from those used in the
clinical practice. In our study, we used the samples with
clinical shapes. The major advantages of using
crown-shaped samples were that we could investigate the
exact artifacts that could be observed clinically, since
MRI is used as a diagnostic tool in radiology and to
control the signal generated. And the study of whether the
galvano-ceramic and metal-ceramic crowns producing
image distortion on MRI is few. Galvano-ceramic
restorations, because of their excellent marginal fit, 14 low
plaque accumulation,15 stabilizing effect on periodontal
tissues over time,16 and warm shade of gold framework,
present optimal biological behavior and improved
aesthetics, as well as galvano-ceramic crowns exhibited
good long-term clinical results.17 So galvano-ceramic
restorations will be a valuable alternative in dentistry. The
purpose of the current comparative in vitro study was to
evaluate the artifacts from galvano-ceramic and metal-
DOI: 10.3760/cma.j.issn.0366-6999.2010.02.016
Department of Prosthodontics, Key Laboratory for Oral
Biomedical Engineering of Ministry of Education, Stomatology
Hospital, Wuhan University, Wuhan, Hubei 430079, China (Chen
DP and Wang YN)
Department of Radiology, Zhongnan Hospital, Wuhan University,
Wuhan, Hubei 430071, China (Wu GY)
Correspondence to: Prof. WANG Yi-ning, Department of
Prosthodontics, Key Laboratory for Oral Biomedical Engineering
of Ministry of Education, Stomatology Hospital, Wuhan
University, Wuhan, Hubei 430079, China (Tel: 86-27-87686318.
Email: wang.yn@whu.edu.cn)
 Table 1. Characteristics of sample materials
Sample Composition by weight Manufacturer
RE Polymethyl methacrylate Heraeus, Germany
Bio98 Au (86.2%), Pt (11.5%), Zn (1.5%), Ru (0.4%), Ta (0.3%), Mn (0.1%) Heraeus, Germany
GA Au (99.9%) C Hafner, Germany
Wiron99 Ni (61.0%), Cr (22.5%), Mo (9.5%), Nb (7.0%), Si (7.0%), Fe (7.0%), Ce (7.0%) BEGO, Germany
SP-78 Pd (78.8%), Au (2.0%), Cu (10%), Ga (9%), Ir (0.2%) Ivoclar-Williams, USA
BioKC97 Au (86.5%), Pt (11.0%), In (1.7%), Fe (0.6%), Ir (0.1%) YaLian, China

ceramic crowns in magnetic resonance imaging, in order
to analyze their influences on diagnostic interpretation of
MRI from head and neck regions in patients.
METHODS
Preparation of samples
To evaluate the artifacts from galvano-ceramic and metal-
ceramic crowns in MRI, 4 kinds of dental casting alloys
were selected to fabricate the coppings of metal-ceramic
crowns (BioKC97, SP-78, Bio98, Wiron99), a resin tooth
model as a negative control (RE) and electroforming
technique to fabricate the copping of galvano-ceramic
crown (GA). The characteristics of sample materials are
listed in Table 1.
To prepare a similar shape for all samples, an upper
incisor was selected and two impressions were made with
a polyether impression material (3M ESPE, USA) before
and after tooth preparation. Six master dies were
duplicated with post-operative impression. One was resin
die and the others were stone dies. Then metal-ceramic,
galvano-ceramic and resin crowns were fabricated with
stone master dies according to the manufacturers’
directions. And to standardize the copping sizes of metal-
ceramic crowns, cutting back technique was used to
make the wax pattern of the copping.18
Phantom
A cylindrical acrylic resin phantom 19 (outer diameter, 56
mm; inner diameter, 50 mm; depth, 50 mm) with a cover
5 mm thick and a positioning resin die at the center was
prepared. Each sample was attached to the resin die. The
phantom was filled with distilled water and closed
without any bubbles inside.
MRI
The phantom with a sample on the positioning resin die
was placed on the table of the MRI apparatus (1.5 T,
Magnetom Vision, Siemens, German). The laser beam of
the MR system was centered on the sample. With a body
coil, all samples were imaged in 3 pulse sequences.
Specific conditions for the sequences were: T1-weighted
spin echo (repetition time (TR) 400 msec, echo time (TE)
12 msec, number of acquisitions (AC) 4, flip angle (FA)
180°), T2-weighted spin echo (TR 3000 msec, TE 96
msec, ETL 12, AC 4, FA 180°), GE (TR 300 msec, TE16
msec, AC 4, FA 30°). Slice thicknesses of 5 mm, field of
view 135 mm, and matrix size of 228 × 256 were used for
all sequences. Longitudinal sections through the center of
each sample, parallel to the Y-Z plane, were imaged.
Imaging of each sample was repeated 3 times with
parameters of imaging sequences reset each time.
A region of interest (ROI) was drawn around the image of
sample (500 mm2) enclosing the whole artifacts with the
proprietary software installed for data acquisition, data
processing. Mean value and standard deviation (SD) of
the signal intensity (SI) for the entire ROI were obtained
from the 3 independent imaging sessions for each sample
to evaluate the heterogeneity in the SI distribution.
Statistical analysis
Statistical analyses were performed with the use of SPSS
15.0. Equality of error variances was assessed by using
Levene’s test. This was followed by post-hoc multiple
comparisons using LSD’s honestly significant difference
test for cases with equal variances. Data were showed as
mean±SD. Statistical significance was set at P < 0.05.
RESULTS
MRI of the samples were shown in the Figure. Artifacts
appear as mushroom-like signal loss, signal loss
surrounded by bright line, and blurring on nonlinear
distortions. Images showed that the greatest artifact was a
25 mm ring with distortion in group Wiron99.
The mean values (pixels) and SD of SI in the ROI
obtained from average of the 3 measurements with 95%
confidence interval (95% CI) for longitudinal MRI of the
samples are shown in Table 2.
Table 2. Mean values (pixels) and standard deviation of signal
intensity distribution in the ROI
Sample T1 T2 GE
RE 207.84±5.02 413.77±2.75 388.28±5.24
Bio98 205.12±6.86 412.27±2.00 365.04±3.47
GA 209.23±6.89 412.27±2.62 385.62±1.27
Wiron99 185.57±3.35 356.49±4.29 175.02±2.78
SP-78 205.19±2.32 410.93±2.22 326.46±1.77
BioCK97 186.99±2.10 383.27±1.83 245.42±0.22
The mean values of SI for Wiron99, BioKC97 were
significantly different from that of RE in T1, T2-weighted
SE and GE sequence (P=0.000). The mean value of SI for
Bio98 was not significantly different from that of RE in
T1-weighted SE (0.503) and T2-weighted SE (0.517).
The mean value of SI for SP-78 was not significantly
different from that of RE in T1-weighted SE (0.515) and
T2-weighted SE (0.228). However, the mean values of SI
for Bio98, SP-78 were significantly different from that of
RE in GE sequence (P=0.000). Only the mean value of SI
for GE was not different from that of RE in T1 FSE
 Figure. MRI and illustration of ROI around sample. T1-weighted images: Bio98 (A), GA (D), Wiron99 (G), SP-78 (J) and BioCK97 (M).
T2-weighted images: Bio98 (B), GA (E), Wiron99 (H), SP-78 (K) and BioCK97 (N). GE images: Bio98 (C), GA (F), Wiron99 (I), SP-78
(L) and BioCK97 (O).

(P=0.732), T2 FSE (P=0.516) and GE sequence we confirmed the appearance of moderate-magnitude

(P=0.291). artifacts from gold alloys in the GE sequences, which
superimposes a small magnetic field onto the main field
DISCUSSION
and is therefore the most metal-sensitive sequence. And
most of the previous studies used the samples with shapes
In this study, we found that galvano-ceramic crown
different from those used in the clinical practice.9-13 In our
showed no artifact in the MRI. The artifact size from
study, the ceramic crowns used as samples, the
metallic objects in MRI is primarily dependent on the
compositions and shapes of the samples as used in the
intensity, inhomogeneity of the magnetic field and the
clinical practice, we could investigate the exact artifacts
magnetic susceptibility of the specific materials used to
observed clinically, since MRI is used as a diagnostic tool
make the object.6,10,13 Magnetic susceptibility is one of
in radiology and to control the signal generated.
the physical properties of material and can be defined as
the ratio of magnetic response of a material to the applied
There are three types of substances, according to their
magnetic field. The copping of galvano-ceramic crown is
magnetic susceptibilities, that need to be considered in
composed of 99.9% Au, which is a material with low
MRI, namely, paramagnetic, ferromagnetic and
magnetic susceptibility,13 so in the present study it
diamagnetic. Paramagnetic substances can cause an
showed no artifact in the MRI.
increase in the effective magnetic field. Ferromagnetic
substances are strongly attracted by a magnetic field and
To our knowledge, no quantitative studies evaluating the
thus have high magnetic susceptibility. Iron, cobalt, and
magnitude of metal artifacts in MRI have been reported.
nickel are three types of ferromagnets. Diamagnetic
Some paradoxical results were reported about metal
substances have a small negative magnetic susceptibility
artifacts from gold alloy in spin-echo sequences. Some
and are basically non-magnetic. The copping of Bio98,
studies reported that gold alloy had no significant metal
SP-78 are composed of diamagnetic elements and other
artifacts in spin-echo sequences,8,20,21 In contrast, several
paramagnetic elements without ferromagnetic elements.
authors have reported that gold alloys produced
So Bio98 and SP-78 have produced moderate artifacts
minimum-to-moderate-magnitude artifacts in the spin-
only in GE sequences. The copping of Wiron99 is
echo sequence.12,22 And one clinical research indicated
composed of ferromagnetic elements with other
that the sagittal T1-weighted MRI clearly showed
paramagnetic elements, and then it has produced severe
distortion around jaw from gold crown. 23 The
artifacts in T1, T2 and GE sequences. Though the most of
contradictory results reported in the literature might be
BioKC97 are composed of diamagnetic elements and
due to differences in the parameters used in MRI, such as
other paramagnetic elements, it has also produced severe
magnetic field intensity and specific sequences, trace
artifacts in T1, T2 and GE sequences. According to
amounts of ferromagnetic substances from the samples,
Eggers et al,24 even small amounts of a ferromagnetic
and geometric factors in the imaging. In the present study,
substance can cause an extensive blank in the image. So
Chinese Medical Journal 2017; 123(2):208-
211
we assumed that the phenomenon had been generated by
the minor ferromagnetic elements (Fe) of BioKC97.
However, how many ferromagnetic substances the dental
materials have can generate artifacts in MRI, needs to be
studied further.
The limitation of this study is that the size of the phantom
is small so that we could not draw the ROI far away from
sample. According to the results, it is certain that the
metal-ceramic crowns can generate artifacts locally in the
MRI, but whether the metal-ceramic crowns can influence
the far-distance region in the MRI is uncertain. So it is
necessary to evaluate their influences on the different ROI
in the next study.
It would be difficult in the diagnostic interpretation of
MRI from head and neck regions in patients with dental
casting alloys that produce artifacts in the magnetic field.
Therefore, materials for prosthetic restoration should be
selected based not only on their biological compatibility
and functional and esthetic qualities, but also on whether
they generate minimum artifacts in MRI. Thus galvano-
ceramic restorations will be a valuable alternative in
dentistry.
Within the limitations of this in vitro study, galvano-
ceramic crown had no influence on the diagnostic
interpretation of MRI. However, metal-ceramic crowns
caused moderate artifacts in the MRI and could influence
the diagnostic interpretation of MRI locally.
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Edited by PAN Cheng