Evaluation of the marginal fit of a zirconia ceramic computer-aided machined (CAM) crown system

Micrometric precision of prosthetic dental crowns obtained by optical scanning and computer-aided designing/computer-aided manufacturing system

The current study evaluated prosthetic dental crowns obtained by optical scanning and a computer-aided designing/computer-aided manufacturing system using micro-computed tomography to compare the marginal fit. The virtual models were obtained with four different scanning surfaces: typodont (T), regular impressions (RI), master casts (MC), and powdered master casts (PMC). Five virtual models were obtained for each group. For each model, a crown was designed on the software and milled from feldspathic ceramic blocks. Micro-CT images were obtained for marginal gap measurements and the data were statistically analyzed by one-way analysis of variance followed by Tukey's test. The mean vertical misfit was T = 62.6 ± 65.2 μm ; MC = 60.4 ± 38.4 μm; PMC = 58.1 ± 38.0 μm, and RI = 89.8 ± 62.8 μm. Considering a percentage of vertical marginal gap of up to 75 μm, the results were T = 71.5%, RI = 49.2%, MC = 69.6%, and PMC = 71.2%. The percentages of horizontal overextension were T = 8.5%, RI = 0%, MC = 0.8%, and PMC = 3.8%. Based on the results, virtual model acquisition by scanning the typodont (simulated mouth) or MC, with or without powder, showed acceptable values for the marginal gap. The higher result of marginal gap of the RI group suggests that it is preferable to scan this directly from the mouth or from MC.

Comparison of internal fit between implant abutments and cast metal crowns vs laser-sintered crowns

AIM

A common problem related to cemented single crowns is the internal misfit, which may cause inadequate retention, especially when seated on the implant abutment. The aim of this study was to compare the internal fit of Co-Cr crowns using a traditional lost-wax casting technique from laser-sintered Co-Cr alloy crowns.

MATERIALS AND METHODS

Twelve metallic crowns per each technique were fabricated. The effect of the thickness of cement, originated internal gap was evaluated. Crowns were cemented on the implant abutments with resin cement, and the internal fit of crowns was measured at five areas with an optical microscope. The data were analyzed, and the means were compared with a t-test (p<0.05).

RESULTS

The internal gap width measurements for the laser-sintered group (min. 52.19 ± 11.61 μm and max. 140.01 ± 31.84 μm) indicated the presence of a significantly closed internal gap compared to the crowns obtained through the lost wax method (min. 65.50 ± 9.54 μm and max. 313.46 ± 48.12 μm).

CONCLUSION

The fit of the metal crown likely varies with the fabrication technique. The use of techniques that enable the adjustment of crown parameters, such as the laser sintering technique, maintains the desired fit between casting and implant abutments.

CLINICAL SIGNIFICANCE

This study investigated which technique affects the internal fit of cemented implant-supported crowns, comparing the use of lost wax casting and laser-sintered metal dental alloys. The results of this study indicate that the use of laser-sintered crowns can improve for crown accuracy.

Comparison of Marginal Gap and Microleakage in Copy-Milled and Cad-Milled Zirconia Copings Bonded Using Light Cure and Chemical Cure Resin Bonding Systems

This in vitro study assessed the marginal gap and marginal microleakage in zirconia copings fabricated using two computer aided techniques- CAD milling and Copy milling and cemented to respective tooth preparations using two resin bonding systems, light cure and self-cure resin bonding systems. 32 extracted premolars were prepared to receive zirconia copings fabricated using CAD/CAM and Copy milling techniques. Once the copings were fabricated, the samples were evaluated for marginal fit prior to cementation through microscopic observation. Evaluation of marginal gap was done again after cementation, in order to incorporate the influence of the resin bonding system on the marginal microgap. The specimens were evaluated under the stereomicroscope for micro-leakage using commercial software. A comparative statistical analysis was done following data collection using Mann-Whitney U test, Wilcoxon test and chi-square test. The data collected regarding marginal gap was well within 120 µ, which is in accordance with previous studies. However, Copy milled specimens showed statistically lesser marginal gap when compared to CAD milled specimens. While comparing microleakage, it was observed that the microleakage in Copy milled specimens bonded with light cure resin bonded cement was statistically lesser than that of specimens cemented with chemical cure resin cement.(P = 0.003). This in vitro study concluded that Copy milling technique fabricated zirconia restorations with lesser marginal gap and microleakage score in comparison to CAD milled samples. Light cure resin bonding system also proved to be more effective option compared to self cure resin bonding systems. However, the limitations of this study should be taken into concern and further research should be aimed at a larger sample size to validate the results.

Evaluation of different approaches for using a laser scanner in digitization of dental impressions

PURPOSE

This study aimed to investigate the potential clinical application of digitized silicone rubber impressions by comparing the accuracy of zirconia 3-unit fixed partial dentures (FPDs) fabricated from 2 types of data (working model and impression) obtained from a laser scanner.

MATERIALS AND METHODS

Ten working models and impressions were prepared with epoxy resin and vinyl polysiloxane, respectively. Based on the data obtained from the laser scanner (D-700; 3Shape A/S, Copenhagen, Denmark), a total of 20 zirconia frameworks were prepared using a dental CAD/CAM system (DentalDesigner; 3shape A/S, Copenhagen, Denmark / Ener-mill, Dentaim, Seoul, Korea). The silicone replicas were sectioned into four pieces to evaluate the framework fit. The replicas were imaged using a digital microscope, and the fit of the reference points (P1, P2, P3, P4, P5, P6, and P7) were measured using the program in the device. Measured discrepancies were divided into 5 categories of gaps (MG, CG, AWG, AOTG, OG). Data were analyzed with Student's t-test (α=0.05), repeated measures ANOVA and two-way ANOVA (α=0.05).

RESULTS

The mean gap of the zirconia framework prepared from the working models presented a narrower discrepancy than the frameworks fabricated from the impression bodies. The mean of the total gap in premolars (P=.003) and molars (P=.002) exhibited a statistical difference between two groups.

CONCLUSION

The mean gap dimensions of each category showed statistically significant difference. Nonetheless, the digitized impression bodies obtained with a laser scanner were applicable to clinical settings, considering the clinically acceptable marginal fit (120 µm).

Impact of digital impression techniques on the adaption of ceramic partial crowns in vitro

OBJECTIVES

To investigate the effects, digital impression procedures can have on the three-dimensional fit of ceramic partial crowns in vitro.

METHODS

An acrylic model of a mandibular first molar was prepared to receive a partial coverage all-ceramic crown (mesio-occlusal-distal inlay preparation with reduction of all cusps and rounded shoulder finish line of buccal wall). Digital impressions were taken using iTero (ITE), cara TRIOS (TRI), CEREC AC with Bluecam (CBC), and Lava COS (COS) systems, before restorations were designed and machined from lithium disilicate blanks. Both the preparation and the restorations were digitised using an optical reference-scanner. Data were entered into quality inspection software, which superimposed the records (best-fit-algorithm), calculated fit-discrepancies for every pixel, and colour-coded the results to aid visualisation. Furthermore, mean quadratic deviations (RMS) were computed and analysed statistically with a one-way ANOVA. Scheffé's procedure was applied for multiple comparisons (n=5, α=0.05).

RESULTS

Mean marginal (internal) discrepancies were: ITE 90 (92) μm, TRI 128 (106) μm, CBC 146 (84) μm, and COS 109 (93) μm. Differences among impression systems were statistically significant at p<0.001 (p=0.039). Qualitatively, partial crowns were undersized especially around cusp tips or the occluso-approximal isthmus. By contrast, potential high-spots could be detected along the preparation finishline and at central occlusal boxes.

CONCLUSIONS

Marginal and internal fit of milled lithium disilicate partial crowns depended on the employed digital impression technique.

CLINICAL SIGNIFICANCE

The investigated digital impression procedures demonstrated significant fit discrepancies. However, all fabricated restorations showed acceptable marginal and internal gap sizes, when considering clinically relevant thresholds reported in the literature.

Marginal Fit of Implant-Supported All-Ceramic Zirconia Frameworks

This study evaluated the effect of fabrication techniques and cyclic loading on the vertical marginal fit of implant-supported fixed partial denture (FPD) frameworks. Thirty implant-supported 3-unit FPD frameworks were fabricated on a model system, divided into 3 equal groups (n = 10). The first group (control) was constructed from base metal alloy; the other 2 test groups were constructed from all-ceramic zirconia using a computer-aided design/computer-aided manufacturing (CAD/CAM) Cerec 3 system and a copy milling (Zirkonzahn) system. A cyclic load of 200 N was applied to each framework for up to 50,000 cycles. Linear measurements were made in micrometers of the vertical gap between the framework and the implant-supported abutment at 16 predetermined points before and after cyclic loading. The frameworks were viewed using scanning electron microscopy to inspect any fractographic features. One-way analysis of variance was performed to compare the marginal discrepancy values of the control and the 2 test groups and for each group; a t test was applied to determine whether significant changes in the fit were observed after cyclic loading (α = 0.05). The CAD/CAM group showed significantly higher marginal gap mean values (80.58 μm) than the Zirkonzahn and control groups (50.33 μm and 42.27 μm, respectively) with no significant difference. After cyclic loading, the CAD/CAM group recorded the highest marginal gap mean value (91.50 ± 4.260 μm) followed by control group (72.00 ± 2.795 μm); the Zirkonzahn group recorded the lowest marginal gap (65.37 ± 6.138 μm). Cyclic loading significantly increased the marginal gap mean values in the control group only. A marginal chip was observed in one of the CAD/CAM ceramic frameworks. Within the limitations of this study, the fabrication technique influenced the marginal fit of the implant-supported 3-unit FPD frameworks. Cyclic loading failed to change the fit of all-ceramic zirconia frameworks, whereas significant changes were found in the metal frameworks.

Internal adaptation, marginal accuracy and microleakage of a pressable versus a machinable ceramic laminate veneers

OBJECTIVES

The aim of this study was to evaluate the internal adaptation and marginal properties of ceramic laminate veneers fabricated using pressable and machinable CAD/CAM techniques.

MATERIALS AND METHODS

40 ceramic laminate veneers were fabricated by either milling ceramic blocks using a CAD/CAM system (group 1 n=20) or press-on veneering using lost wax technique (group 2 n=20). The veneers were acid etched using hydrofluoric acid, silanated, and cemented on their corresponding prepared teeth. All specimens were stored under water (37 °C) for 60 days, then received thermocycling (15,000 cycles between 5 and 55 °C and dwell time of 90 s) followed by cyclic loading (100,000 cycles between 50 and 100 N) before immersion in basic fuchsine dye for 24 h. Half of the specimens in each group were sectioned in labio-lingual direction and the rest were horizontally sectioned using precision cutting machine (n=10). Dye penetration, internal cement film thickness, and vertical and horizontal marginal gaps at the incisal and cervical regions were measured (α=0.05).

RESULTS

Pressable ceramic veneers demonstrated significantly lower (F=8.916, P<0.005) vertical and horizontal marginal gaps at the cervical and incisal margins and lower cement film thickness (F=50.921, P<0.001) compared to machinable ceramic veneers. The inferior marginal properties of machinable ceramic veneers were associated with significantly higher microleakage values.

CONCLUSIONS

Pressable ceramic laminate veneers produced higher marginal adaptation, homogenous and thinner cement film thickness, and improved resistance to microleakage compared to machinable ceramic veneers.

CLINICAL SIGNIFICANCE

The manufacturing process influences internal and marginal fit of ceramic veneers. Therefore, dentist and laboratory technicians should choose a manufacturing process with careful consideration.