Marginal adaptation of castable ceramic crowns

Accuracy, adaptation and margin quality of monolithic zirconia crowns fabricated by 3D printing versus subtractive manufacturing technique: A systematic review and meta-analysis of in vitro studies

OBJECTIVE

The purpose of this systematic review and meta-analysis was to evaluate the accuracy (trueness and precision), marginal and internal adaptation, and margin quality of zirconia crowns made by additive manufacturing compared to subtractive manufacturing technology.

METHODS

The investigation adhered to the PRISMA-ScR guidelines for systematic reviews and was registered at the Prospero database (n°CRD42023452927). Four electronic databases, including PubMed, Scopus, Embase, and Web of Science and manual search was conducted to find relevant studies published until September 2023. In vitro studies that assessed the trueness and precision, marginal and internal adaptation, and margin quality of printed crowns compared to milled ones were included. Studies on crowns over implants, pontics, temporary restorations, laminates, or exclusively experimental materials were excluded.

RESULTS

A total of 9 studies were included in the descriptive reporting and 7 for meta-analysis. The global meta-analysis of the trueness (P<0.74,I2=90 %) and the margin quality (P<0.61,I2=0 %) indicated no significant difference between the root mean square of printed and milled zirconia crowns. The subgroup analysis for the printing system showed a significant effect (P<0.01). The meta-analysis of the crown areas indicated no significant difference in most of the areas, except for the marginal (favoring milled crowns) and axial (favoring printed crowns) areas. For precision and adaptation, both methods showed a clinically acceptable level.

CONCLUSIONS

Additive manufacturing technology produces crowns with trueness and margin quality comparable to subtractive manufacturing. Both techniques have demonstrated the ability to produce crowns with precision levels, internal discrepancy, and marginal fit within clinically acceptable limits.

CLINICAL SIGNIFICANCE

3D printing emerges as a promising and potentially applicable alternative method for manufacturing zirconia crowns, as it shows trueness and margin quality comparable to restorations produced by the subtractive method.

Influence of various fabrication techniques and porcelain firing on the accuracy of metal-ceramic crowns

BACKGROUND

The fit of a metal-ceramic restoration is essential to its long-term durability. Regarding marginal and internal fit, there is not enough information about the technologies used in the production of metal-ceramic restorations. The aim of this in vitro study is to compare, both before and after porcelain firing, the marginal, axial, axio-occlusal, and occlusal fit of metal-ceramic restorations manufactured using casting, additive or subtractive computer-aided design, and computer-aided manufacturing techniques (CAD/CAM).

METHODS

CAD/CAM were used to create 50 prepared maxillary first molar-shaped Co-Cr die models, which were randomly divided into 5 groups (n = 10). Cobalt-chrome copings were produced by casting (C), hard metal milling (HM), soft metal milling (SM), selective laser melting (SLM), and selective laser sintering (SLS) techniques. Before and after porcelain firing, discrepancies of the copings were measured using the silicone replica technique. The data obtained by measurements with a stereomicroscope at x80 magnification were analyzed statistically in the SPSS program. The ROBUST three-way analysis of variance (ANOVA) method was used to compare the discrepancy values.

RESULTS

There were statistically significant differences among fabrication methods (P < .001). The HM method showed the highest discrepancy (90.1 μm), and the C (63 μm) method showed the lowest discrepancy in terms of the die model- crown fit. The C, SLS, and SM methods (63 μm; 61.6 μm; 67.7 μm) were statistically similar (P > .001). The highest discrepancy was observed on the occlusal area (87.1 μm), and the lowest discrepancy was observed on the axial area (47.7 μm) of the coping. Porcelain firing had a decrease in the discrepancy values (P = .001).

CONCLUSION

All CAD/CAM techniques are appropriate for clinical use; selective laser sintering and soft milling can be the more recommended methods for the compatibility of metal-porcelain restorations, as they have lower discrepancy values than the SLM and HM methods.

Examination of the effect of aging process on marginal fit and fractute strength of temporary crowns prepared from different materials

Aim

The aim of this study is to investigate the effect of the aging process on the marginal fit and fracture resistance of temporary crowns prepared using different materials.

Materials and method

The steel die to represent the maxillary first premolar used in this study was produced on a CNC turning machine to include an anatomical occlusal surface. A total of 160 epoxy resin dies were obtained by taking impressions with conventional impression methods on the metal die. Epoxy resin dies were randomly divided into four groups. Temporary crowns were prepared for each group from poly acrylic resin (Vita CADTemp®), bis-acryl composite resin (Protemp 4), poly methyl methacrylate (PMMA; Imident) and poly ethyl methacrylate (PEMA; Dentalon Plus) restorative materials. Half of the specimens (n = 20) in each group (n = 40) were randomly separated and the aging process was applied 5000 times in the device. Marginal gap measurements on epoxy resin dies were made using a stereomicroscope. The fracture strength test of the specimens was performed by using the Instron Universal Test Device. Jamovi 2.2.5 statistical program was used for statistical analysis.

Results

When compared to temporary crowns prepared from all other materials, poly acrylic resin (Vita CADTemp ®) temporary crowns observed significantly lower marginal gap values (59,05 μm) regardless of the aging process, and a significantly higher fracture resistance (478,44 N) in the presence of aging process (p < .05 for each). While the highest marginal gap value was detected in PMMA (Imident) (120.36 μm) temporary crowns with aging process, the lowest marginal gap value was observed in poly acrylic resin (Vita CADTemp®) (59.05 μm) crowns without non-aging process. The marginal fit and fracture resistance of all temporary crowns were negatively affected by the aging process.

Conclusion

Our findings revealed the superiority of poly acrylic resin (Vita CADTemp®) crowns to the temporary crowns prepared from all other materials in terms of the significantly lower marginal gap in the absence of aging process, and the significantly higher fracture resistance in the presence of aging process. Marginal fit and fracture resistance values for all materials were found to be within clinically acceptable limits.

The effect of pre-ceramic soldering on marginal and internal fit of 4-unit zirconia frameworks and monolithic zirconia fixed dental prostheses

The aim of this study is to evaluate the effect of pre-ceramic soldering on the marginal and internal fit of 4-unit zirconia fixed dental prostheses (FPDs) that have two abutments and two pontics. 4-unit zirconia frameworks (Zirkonzahn ICE Translucent) (Z Group) and monolithic zirconia (Zirkonzahn Prettau) (M Group) FPDs were manufactured. Groups were divided into two groups (n = 10) control (ZC and MC) and soldering (ZS and MS). Samples of ZS and MS groups were cut into two pieces under cooling water and soldered with a bonding material (DCM Zircon HotBond). The marginal and internal fit of the restorations were measured from 36 points of each sample and cement space volume was calculated using reverse engineering software (Geomagic Design X). The mean and standard deviations were submitted to Generalized Linear Mixed Model (GLMM) analysis (α = 0.05). Statistical differences between groups before and after pre-ceramic soldering on point measurements were found. In total cement spacing measurements, a significant difference was found amongst all groups (P < 0.05). However, in premolars, a statistically significant difference was found between ZC and ZS groups and MC and MS groups (P < 0.05). All discrepancies after pre-ceramic soldering were found to be lower than before.

Marginal Accuracy of Monolithic and Veneered Zirconia Crowns Fabricated by Conventional and Digital Workflows

PURPOSE

To compare the marginal accuracy of zirconia crowns fabricated by different workflows (conventional and digital) and designs (monolithic and veneered).

MATERIALS AND METHODS

A prepared maxillary first molar was used for the study. Four workflow combinations were evaluated: (1) intraoral scanning and monolithic zirconia (IOS-M), (2) intraoral scanning and veneered zirconia (IOS-V), (3) conventional impression and monolithic zirconia (IMP-M), and (4) conventional impression and veneered zirconia (IMP-V). All of the specimens had similar designs. The veneered groups had a buccal cutback for esthetic veneer application. A total of 10 crowns were produced in each workflow. The vertical and horizontal marginal accuracies were measured with a traveling microscope. Depending on the normality of the data, one-way analysis of variance test or Kruskal-Wallis test were applied to evaluate the differences among the groups (α = 0.05).

RESULTS

The most superior vertical marginal accuracy was observed for IOS-V (mean = 22.5 μm; SD = 6.7 μm), followed by IMP-V (mean = 23.9 μm; SD = 7.8 μm), IOS-M (mean = 28.7 μm; SD = 10.3 μm), and IMP-M (mean = 39.8 μm; SD = 22.0 μm), respectively (p < 0.001). The IOS-M had the greatest mean horizontal discrepancies (mean = 23.9 μm; SD = 4.3 μm) followed by IMP-M (mean = 21.3 μm; SD = 5.7 μm), IMP-V (mean = 19.2 μm; SD = 5.3 μm) and IOS-V (mean = 17.6 μm; SD = 5.7 μm) (p < 0.001).

CONCLUSIONS

Monolithic zirconia crowns fabricated digitally had superior marginal accuracy than monolithic zirconia crowns fabricated conventionally. Esthetic buccal veneering of predominantly monolithic zirconia copings improved the vertical and horizontal marginal accuracies.

Marginal fit of monolithic versus layered zirconia crowns assessed with 2 marginal gap methods

STATEMENT OF PROBLEM

Zirconia can be used either monolithically or veneered with porcelain. However, whether veneering zirconia affects marginal fit is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal fit of the monolithic and layered zirconia prostheses using 2 different assessment methods.

MATERIAL AND METHODS

An ideal complete crown with a chamfer finish line was prepared on an extracted maxillary central incisor. Two prosthesis designs, a framework and a monolithic design, and 2 marginal fit evaluation methods, the silicone replica and the triple scanning techniques, were used. In the first group, 10 crowns were fabricated with the framework design followed by porcelain veneering, and 10 crowns were fabricated monolithically in the second group. The marginal gap in each group was evaluated with both the silicone replica and triple scan methods. Data were statistically analyzed with a 2-way repeated measures ANOVA (α=.05).

RESULTS

A significant difference was found in the mean marginal gap by design type (P=.003), with the monolithic prostheses having lower mean marginal gaps (31.0 and 84.0 µm). However, both groups showed clinically acceptable marginal fit. No significant difference was found between the assessment methods (P=.092).

CONCLUSIONS

Monolithic zirconia crowns had a better marginal fit than veneered zirconia frameworks. Both the replica and triple scan techniques for marginal gap assessment yielded similar results.

Fit of anterior restorations made of 3D-printed and milled zirconia: An in-vitro study

OBJECTIVES

To evaluate the fit of zirconia veneers made by either 3D printing or milling.

METHODS

A typodont maxillary central incisor was prepared for a 0.5-mm-thick veneer and was reproduced 36 times from resin. Restorations were designed with a 20-µm-wide marginal and a 60-µm-wide internal cement gap, and were made from 3D-printed zirconia (LithaCon 3Y 210, Lithoz, n = 24) and milled zirconia (Cercon ht, DentsplySirona, n = 12). For milled zirconia, a drill compensation was needed to give the milling bur access to the intaglio surface. The restorations were cemented, cross-sectioned, and the cement gap size was analyzed by two raters. Inter-rater reliability was studied at 12 3D-printed veneers (intraclass correlation coefficient, ICC, mixed model, absolute agreement). Twelve remaining 3D-printed restorations were compared with 12 milled restorations regarding fit at three locations: marginally, labially, and at the incisal edge (Mann-Whitney U-tests, α<0.05).

RESULTS

Inter-rater reliability was excellent, with an ICC single-measure coefficient of 0.944 (95%-confidence interval: [0.907; 0.966]). Gap sizes (mean ± SD / maximum) were 55 ± 9 / 143 µm at the margins, 68 ± 14 / 130 µm labially, and 78 ± 19 / 176 µm at the incisor edge for 3D-printed veneers. For milled veneers, gap sizes were 44 ± 11 / 141 µm at the margins, 85 ± 19 / 171 µm labially, and 391 ± 26 / 477 µm at the incisor edge. At the margins, the milled veneers outperformed the 3D-printed restorations (p = 0.011). The cement gap at the incisor edge was significantly smaller after 3D printing (p < 0.001).

CONCLUSIONS

3D-printed zirconia restorations showed clinically acceptable mean marginal gaps below 100 µm. Because drill compensation could be omitted with 3D printing, the fit at the sharp incisal edge was significantly tighter than with milling.

CLINICAL SIGNIFICANCE

The fit of 3D-printed ceramic anterior restorations meets clinical standards. In addition, 3D printing is associated with a greater geometrical freedom than milling. With regard to fit this feature allows tighter adaptation even after minimally invasive preparation.

Marginal and Internal Fit of Monolithic Zirconia Crowns Fabricated by Using Two Different CAD-CAM Workflows: An In Vitro Study

Objectives: Few studies have evaluated the marginal fit of computer-aided design—computer-aided manufacturing (CAD-CAM) monolithic zirconia crowns fabricated through completely digital workflow; however, the internal fit of these restorations is not well known. The purpose of this in vitro study was to evaluate the marginal and internal fit of monolithic zirconia crowns fabricated by using digital workflow, including intraoral scanner (IOS) scans, and compare the results to those of a semi-digital workflow, which combined conventional impressions, poured casts, and extraoral scanner (EOS) scanning. Materials and methods: A typodont right mandibular first molar was prepared for a complete-coverage ceramic crown and scanned using an IOS. The conventional impressions of the preparation were also made, and stone casts were poured and scanned by using an EOS. Virtual models were generated for both workflows, and identical virtual anatomic contour crowns were designed using CAD software. Monolithic zirconia crowns were fabricated for both IOS (ZI; n = 10) and EOS (ZE; n = 10) groups. The silicon replica technique was used to evaluate the marginal and internal fit of the crowns. Measurements were made at 13 points on buccolingual and mesiodistal cross-sections per specimen with a ×6.5 to ×50 zoom stereo microscope. The results from both groups were statistically compared using the Independent Samples t-tests and the Mann–Whitney U test (α = 0.05). Results: Mean gap values at all measurement locations for ZE were significantly higher than those for ZI (p ≤ 0.002). Overall mean values ranged between 29 and 43 µm (median: 28–42 µm) for ZI and 42 and 75 µm (median: 43–77 µm) for ZE. Conclusion: Completely digital workflow through intraoral scans provided significantly better marginal and internal fit for CAD-CAM monolithic zirconia crowns compared with the semi-digital workflow, where stone casts obtained from conventional impressions were scanned with an EOS. Yet, both workflows provided an acceptable marginal and internal fit for CAD-CAM monolithic zirconia molar crowns (<120 µm). Clinical Relevance: Completely digital workflow using IOS scans may be advantageous for the fabrication of CAD-CAM monolithic zirconia crowns as favorable results can be obtained with less material waste and potentially shortened overall treatment time as the impression files can be transferred to the production facility electronically. The results need to be corroborated with clinical studies.

Zirconia fixed dental prostheses fabricated by 3D gel deposition show higher fracture strength than conventionally milled counterparts

Zirconia restorations, which are fabricated by additive 3D gel deposition and do not require glazing like conventional restorations, were introduced as "self-glazed" zirconia restorations into dentistry. This in vitro investigation characterized the surface layer, microstructure and the fracture and aging behavior of "self-glazed" zirconia (Y-TZP_SG) three-unit fixed dental prostheses (FDP) and compared them to conventionally CAD/CAM milled and glazed controls (Y-TZP_C-FDPs). For this purpose, the FDPs were analyzed by (focused ion beam) scanning electron microscopy, laserscanning microscopy, energy dispersive X-ray spectroscopy, X-ray diffraction and a dynamic and static loading test. For the latter, half of the samples of each material group (n = 16) was subjected to 5 million cycles of thermocyclic loading (98N) in an aqueous environment in a chewing simulator. Afterwards, all FDPs were loaded to fracture. Y-TZP_SG-FDPs demonstrated a comparable elemental composition but higher surface microstructural homogeneity and fracture strength compared to Y-TZP_C-FDPs. Microstructural flaws within the FDPs' surfaces were identified as fracture origins. The high fracture strength of the Y-TZP_SG-FDPs was attributed to a finer-grained microstructure with fewer surface flaws compared to the Y-TZP_C-FDPs which showed numerous flaws in the glaze overlayer. A decrease in fracture strength after dynamic loading from 5165N to 4507N was observed for the Y-TZP_SG-FDPs, however, fracture strength remained statistically significantly above the one measured for Y-TZP_C-FDPs (before chewing simulation: 1923N; after: 2041N). Within the limits of this investigation, it can therefore be concluded that Y-TZP_SG appears to be stable for clinical application suggesting further investigations to prove clinical applicability.

Evaluation of marginal adaptation and microleakage of differant all-ceramic porcelain systems

ABSTRACT Purpose: This study evaluated the marginal adaptation and microleakage of the İn-Ceram Alumina, In-Ceram Zirconia and Finesse press all-ceramic porcelain systems. Material and methods: Thirty maxillary Central teeth extracted for periodontal reasons without caries and cracks were divided equally into three group and there was no control group; only the three systems were compared. Sample teeth cemented were stored in distile water for 24 hours. Then, they were applied to a repeated thermal cycle for 500 times. The samples were left in %5 of basic fuchsin dye for 24 hours. For the marginal adaptation rankings, all of the sample teeth for which cross-sections were made were moved into the metal microscope (Scherr Turico St. James/ Minn./ USA) and the marginal adaptation degrees were measured in both the palatinal and vestibul regions by measuring twice with x10 enlargement at micron level. For the statistical evaluations of marginal adaptation and microleakage values, Kruskal Wallis test has been used (p>0.05). Results: The differences between the three all-ceramic porcelain systems are not significant (p>0.05), α=0.05). Conclusion: The Finesse porcelain system caused the least leakage in both regions. In second place in both regions was In-Ceram Alumina, In-Ceram Zirconia caused the most leakage in both regions. The biggest margin gap in the palatal region was seen in the Finesse porcelain system, In-Ceram Zirconia in second place. The least marginal gap was caused by the In- Ceram Alumina porcelain system.

Prospective 5-year clinical evaluation of posterior zirconia fixed dental prostheses veneered with milled lithium disilicate (CADon)

OBJECTIVE

Bi-layer zirconia-based posterior fixed dental prostheses (FDPs) have reportedly a high incidence of veneering ceramic fractures. The CADon technique employs zirconia frameworks veneered with milled lithium disilicate glass-ceramic to overcome these shortcomings but long-term clinical studies are missing. This study evaluated the clinical efficacy of posterior 3-unit CADOn FDPs over a 5-year period.

MATERIALS AND METHODS

A total of 25 patients, 16 male and 9 female with a mean age of 55.6 years, received a total of 25 posterior three-unit CADOn FDPs. Patients were recalled for baseline and for follow-up visits at 6, 12, 24, and 60 months. Parameters evaluated were fracture, marginal adaptation, marginal discoloration, wear, polish, color match, surface staining, and retention of these restorations as well as secondary caries of the abutment teeth.

RESULTS

A total of 21 FDPs evaluated at 60-months revealed a 100% survival rate. All evaluated clinical parameters were satisfactory (alpha or bravo) and there was no statistically significant difference at different time points, except for surface staining, which was also worse at 60 months compared to baseline (p  ≤  0.001).

CONCLUSIONS

CADOn three-unit posterior FDPs demonstrate excellent fracture resistance after 5 years of clinical function. All evaluated clinical parameters were satisfactory, except for surface stain, which also increased over time.

CLINICAL SIGNIFICANCE

Conventionally veneered bi-layer zirconia-based posterior FDPs have limited clinical success. Based on this study, alternative methods such as zirconia frameworks veneered with milled lithium disilicate glass-ceramic provide a viable alternative with excellent long-term clinical outcomes.

Marginal and Internal Precision of Zirconia Four-Unit Fixed Partial Denture Frameworks Produced Using Four Milling Systems

Background: CAD/CAM systems enable the production of fixed partial dentures with small and reproducible internal and marginal gaps. Purpose: The purpose of this study was to evaluate the reproducibility of the marginal and internal adaptations of four-unit fixed partial denture frameworks produced using four CAD/CAM systems. Materials and Methods: Prepared dies of a master model that simulated the loss of the first left molar were measured. Fifteen frameworks were manufactured using four CAD/CAM systems (A–D). The internal fit was determined by the replica technique, and the marginal gap was determined by microscopy. ANOVA was carried out to detect significant differences, and the Bonferroni adjustment was performed. The global level of significance was set at 5%. Results: The mean gap size ranged from 84 to 132 µm (SD 43–71 µm). The CAD/CAM systems showed significant variance (p < 0.001), and system A (VHF) showed the smallest gaps. The smallest gaps for each system were in the molar part and in the marginal region of the frameworks (p < 0.001). Conclusions: The CAD/CAM systems showed significantly different gap sizes, particularly between premolars and molars and among the marginal, axial and occlusal regions. All of the systems are suitable for clinical application.

Effects of porcelain veneering methods on conformity of the marginal and internal fit of three-unit zirconia framework

The purpose of this study is to investigate the effects of porcelain veneering methods on the marginal and internal fit of a three-unit zirconia framework. A zirconia master model, in which the lower-left second premolar and the second left molar were used as the abutment, was obtained using an intraoral scanner. Based on the data, three-unit zirconia frameworks for fabricating all-ceramic bridges were designed and milled (FW group). Two types of all-ceramic bridge were fabricated by veneering porcelain onto these frameworks using the press-over technique (P group) and the layering technique (L group). The replica technique was used to measure the gap size between the abutments and the bridges. Measurements were taken in the marginal opening area (MO), chamfer area (CH), axial area (AX), and occlusal area (OC). Statistical analysis was performed using the Mann-Whitney U-test. There was no significant difference in MO and CH between the P and L groups. However, in AX, the L group had a significantly larger gap size than that of the P group (p = 0.003). In addition, compared with the FW group, the P group showed a significantly larger gap size in MO (p < 0.000), CH (p = 0.008), and OC (p < 0.000). These results indicate that the gap size increased after porcelain veneering using the press-over and layering techniques. In addition, the all-ceramic bridges fabricated using the press-over and layering techniques had approximately equal gap sizes in MO.

[Clinical pathway and preparation method of high-precision tooth shoulder platform]

A clear shoulder platform that can be easily identified by doctors and technicians or machines (mouth scan and warehouse scan) is important to obtaining a good long-term and stable fixed prosthesis treatment effect. At present, the pre-paration of the shoulder platform is usually based on free hands, and the practical operation is mainly guided by experience. Moreover, no comprehensive and objective preoperative design, intraoperative verification, and final test are available. Thus, the accuracy of shoulder platform preparation needs to be improved. In this study, the clinical pathway of "three determination, three selection, and three steps" with high accuracy of preparation and the precise shoulder preparation method of "bur-tip guidance" are proposed in detail.

In Vitro Study of Comparative Evaluation of Marginal and Internal Fit between Heat-Pressed and CAD-CAM Monolithic Glass-Ceramic Restorations after Thermal Aging

The accuracy of newly developed ceramic materials is still being studied. Marginal and internal adaptation are known factors that have an essential impact on the long term success of dental restorations. The aim of this in vitro study was to evaluate the marginal and internal fit of heat-pressed and milled monolithic glass-ceramic restorations based on their ceramic type, processing technique, and in vitro thermocycling. Thirty-two crowns were studied and divided into four groups (n = 8), according to the ceramic material (feldspathic glass-ceramic (F) and zirconia reinforced lithium silicate glass-ceramic (ZLS)) and to their technological obtaining processes (milling (M) and heat-pressing (P)). A typodont preparation was scanned with a D2000 3D scanner to obtain identical 32 resin 3D-printed abutment teeth. Marginal and internal gaps were measured using the silicone replica technique under 40× magnification. The crowns were further cemented and thermally aged for 10,000 cycles After cementation and thermocycling of the samples, marginal and internal gaps were assessed using micro-CT (micro-computed tomography)) analysis. Data were statistically analyzed using statistical tests. Significant differences were found before and after cementation and thermocycling among the tested materials (p < 0.05). Related to technological processing, significant differences were seen in the marginal area between FP and FM (p < 0.05) Significant differences were also found in the axial and occlusal areas between the ZLSP and ZLSM. Thermocycling and cementation did not have a significant effect on the tested materials (p < 0.05). The technological processes influenced the marginal and internal fit of the crowns in favor of the CAD/CAM (computer aided design/computer aided manufacturing)technologies. Thermal aging had little effect on marginal adaptability; it increased the values for all the tested samples in a small way, but the values remained in their clinically acceptable range for all of the crowns.

Comparison of three-dimensional digital technique with two-dimensional replica method for measuring marginal and internal fit of full coverage restorations

PURPOSE

This study compared digital (reference point matching) and replica methods for measuring marginal and internal fit of full coverage restorations.

MATERIALS AND METHODS

A maxillary left first molar typodent was fixed on to an aluminum base and prepared to receive all-ceramic full coverage restoration. The model was scanned with an intraoral scanner (CEREC Omnicam, Sirona, York, PA, USA). Twelve crowns were fabricated from lithium disilicate blocks (IPS emax CAD, Ivoclar Vivadent) and then crystalized. Marginal and internal fit of each restoration was measured by two examiners using replica and a new digital three-dimensional technique. Reliability between the two methods and two examiners was assessed by correlation and Cronbach's Alpha coefficient (P<.05). A Bland-Altman assessment for agreement was used to compare the two methods.

RESULTS

Bland-Altman assessment showed that the mean of difference for marginal, absolute marginal, and axial gap was respectively -1.04 µm, -41.9 µm, and -29.53 µm with limit of agreement (LOA) between -37.26 to 35.18 µm for marginal, -105.85 to 22.05 µm for absolute marginal and -80.52 to 22.02 µm for axial gap. Positive correlation for repeatability (P<.05) in determining marginal and internal gaps by the two examiners in both techniques was revealed. Reliability of both techniques in all sites of measurements was at least good (0.8 ≤ α < 0.9).

CONCLUSION

Both measuring techniques appeared highly reliable for evaluating fit of fixed dental restorations, while reference point matching provided higher values in axial and absolute marginal gap assessment.

[Influence of preparation height and cement space on the fit and retention of computer aided design/computer aided manufacturing zirconia crown]

OBJECTIVE

To investigate the effects of preparation height and cement space on the fit and retention of computer aided design (CAD)/computer aided manufacturing (CAM) zirconia crown, and to provide reference for the clinical design and fabrication of CAD/CAM crowns.

METHODS

3D printing system was used to fabricate resin abutment teeth with convergence angle of 2° and height of 1-3 mm. The models' optical impressions were collected by the three-shape scanner. Then, the cement spaces were set by Cradle CAD/CAM system at 10-50 μm to create an all-ceramic zirconia crown. The fit of the crowns was measured by using silicone rubber interstitial impression method. The retention of the crowns was measured by pull-off test with uniaxial tensile force after the crown was bonded. The data were analyzed by SPSS 22.0 soft-ware.

RESULTS

When the preparation height was fixed, the fitness values of different cement space groups have statistical difference (P<
0.05), whereas the retention values of different cement space groups have no statistical difference (P>0.05). The fitness values of different preparation height groups have no statistical difference (P>0.05), and the retention values of different preparation height groups have statistical difference (P<0.05) when the cement space was fixed. No interaction was observed between the cement space and the preparation height (P>0.05).

CONCLUSIONS

When cradle CAD/CAM system is used to create a full crown in the clinic, the preparation height should be set to more than 3 mm, and the cement space should be set at 30 μm.

Effect of finish line design and metal alloy on the marginal and internal gaps of selective laser melting printed copings

STATEMENT OF PROBLEM

Selective laser melting (SLM) technology has been introduced for printing metal dental restorations from Co-Cr base alloys or Au-Pt high noble alloys. However, information regarding the fit of restorations fabricated by using this technique is limited.

PURPOSE

The purpose of this in vitro study was to determine the effect of 3 different finish line designs on the marginal and internal gaps of metal copings made from a base (Co-Cr), high noble (Au-Pd-Ag), and noble alloy (Co-Pd) by using the SLM technology.

MATERIAL AND METHODS

Three Ivorine right maxillary central incisors were prepared with a chamfer, deep chamfer, or shoulder finish line. The preparations were scanned by using a TRIOS scanner, and a total of 90 dies were printed using DPR 10 Resin (30×3 finish line designs). Ten SLM copings were fabricated for each margin design and metal alloy combination for a total of 90 copings (10×3 finish line designs×3 alloys). Copings were cemented onto dies using an autopolymerizing composite-resin luting material. All coping-die assemblies were sectioned buccolingually by using a low-speed diamond saw, and images were obtained by using an inverted bright field metallurgical microscope at ×100 magnification. Marginal and internal gaps were measured at 5 locations: buccal margin, midfacial, incisal, midlingual, and lingual margin. After gap measurements, representative specimens were embedded in autopolymerizing resin and prepared for metallographic examination. A 2-way multivariate analysis of variance (MANOVA) was conducted to determine the overall significance, followed by ANOVA for each dependent variable (α=.05).

RESULTS

The results indicated that alloy type and finish line had a significant influence on marginal gap of copings (P<.001). Relative to the internal gap, alloy type had a significant effect (P<.001), but the type of finish line had no statistically significant influence (P=.337). No statistically significant interactions occurred. Base alloys were printed with almost no observable porosity, whereas noble and high noble alloys exhibited hot tears and porosity.

CONCLUSIONS

Thefinish line type did not influence the internal gap between copings and dies, whereas the alloy type influenced the marginal gap between copings and dies. SLM-fabricated Co-Cr copings on teeth prepared with a deep chamfer finish line demonstrated the lowest marginal gap.

Remake Rates for Single-Unit Crowns in Clinical Practice: Findings from The National Dental Practice-Based Research Network

PURPOSE

Some crowns returned from the laboratory are clinically unacceptable, and dentists must remake them. The objectives of this study were to: (1) quantify the remake rate of single-unit crowns; and (2) identify factors significantly associated with crown remakes and intraoral fit.

MATERIALS AND METHODS

Dentists participating in the National Dental Practice-Based Research Network recruited patients needing crowns and documented fabrication techniques, patient characteristics, and outcomes. Crowns were considered clinically acceptable or rejected. Also, various aspects of the clinical fit of the crown were graded and categorized as 'Goodness of Fit (GOF).' Dentist and patient characteristics were tested statistically for associations with crown acceptability and GOF.

RESULTS

More than 200 dentists participated in this study (N = 205) and evaluated 3750 single-unit crowns. The mean age (years) of patients receiving a crown was 55. The remake rate for crowns was 3.8%. The range of rejection rates among individual practitioners was 0% to 42%. Most clinicians (118, or 58%) did not reject any crowns; all rejections came from 42% of the clinicians (n = 87). The most common reasons for rejections were proximal misfit, marginal errors, and esthetic failures. Fewer years in practice was significantly associated with lower crown success rates and lower fit scores. GOF was also associated with practice busyness and patient insurance status, patient gender (dentists reported better fit for female patients), and patient ethnicity.

CONCLUSIONS

The crown remake rate in this study was about 4%. Remakes and crown GOF were associated with certain dentist and practice characteristics.

Comparative Evaluation of Marginal Adaptation and Fracture Strength of Different Ceramic Inlays Produced by CEREC Omnicam and Heat-Pressed Technique

Objective

The aim of this in vitro study was to evaluate marginal adaptation and fracture strength of inlays produced by CEREC Omnicam using different types of blocs and heat-pressed technique. Methods: Seventy-five extracted human mandibular molars were divided randomly into 5 groups (n=15). 60 molars in four groups received MOD inlay preparations. Experimental groups were CO: Intact teeth, EC: IPS e.max CAD and CEREC, LU: Lava Ultimate and CEREC, EL: IPS Empress CAD and CEREC, EP: IPS Empress Esthetic ingots and heat-pressed technique. Marginal gap measurements were taken with a stereomicroscope. Restorations were cemented with Variolink N and stored in distilled water at 37°C for 24 hours. All samples were subjected to thermocycling. The fracture strength of specimens was determined at a 0.5 mm/min crosshead speed until fracture. Fracture modes were determined. Statistical analyses were performed using one-way analysis of variance for fracture strength data and Kruskal–Wallis for marginal gap data (p=0.05).

Results

The mean marginal gap size of EC, LU, EL, and EP were 33.54 µm, 33.77 µm, 34.23 µm, and 85.34 µm, respectively. EP had statistically higher values than other groups. The fracture strength values were significantly higher in the intact teeth group (3959,00 ± 1279,79 N) than those of restored groups EC (2408,00 ± 607,97 N), LU (2206,73 ± 675,16), EL (2573.27 ± 644,73) ve EP (2879,53 ± 897,30).

Conclusion

Inlays fabricated using CEREC Omnicam demonstrated better marginal adaptation than inlays produced with heat-pressed technique, whereas fracture strength values of inlays fabricated with different type of blocks using CEREC Omnicam exhibited similarity to those fabricated with heat-pressed technique.

Digital evaluation of absolute marginal discrepancy: A comparison of ceramic crowns fabricated with conventional and digital techniques

STATEMENT OF PROBLEM

Marginal discrepancy is key to evaluating the accuracy of fixed dental prostheses. An improved method of evaluating marginal discrepancy is needed.

PURPOSE

The purpose of this in vitro study was to evaluate the absolute marginal discrepancy of ceramic crowns fabricated using conventional and digital methods with a digital method for the quantitative evaluation of absolute marginal discrepancy. The novel method was based on 3-dimensional scanning, iterative closest point registration techniques, and reverse engineering theory.

MATERIAL AND METHODS

Six standard tooth preparations for the right maxillary central incisor, right maxillary second premolar, right maxillary second molar, left mandibular lateral incisor, left mandibular first premolar, and left mandibular first molar were selected. Ten conventional ceramic crowns and 10 CEREC crowns were fabricated for each tooth preparation. A dental cast scanner was used to obtain 3-dimensional data of the preparations and ceramic crowns, and the data were compared with the "virtual seating" iterative closest point technique. Reverse engineering software used edge sharpening and other functional modules to extract the margins of the preparations and crowns. Finally, quantitative evaluation of the absolute marginal discrepancy of the ceramic crowns was obtained from the 2-dimensional cross-sectional straight-line distance between points on the margin of the ceramic crowns and the standard preparations based on the circumferential function module along the long axis.

RESULTS

The absolute marginal discrepancy of the ceramic crowns fabricated using conventional methods was 115 ±15.2 μm, and 110 ±14.3 μm for those fabricated using the digital technique was. ANOVA showed no statistical difference between the 2 methods or among ceramic crowns for different teeth (P>.05).

CONCLUSIONS

The digital quantitative evaluation method for the absolute marginal discrepancy of ceramic crowns was established. The evaluations determined that the absolute marginal discrepancies were within a clinically acceptable range. This method is acceptable for the digital evaluation of the accuracy of complete crowns.

Marginal discrepancy dimensions of single unit metal crowns fabricated by using CAD-CAM-milled acrylate resin polymer blocks or a conventional waxing technique

STATEMENT OF PROBLEM

Because crowns with open margins are a well-known problem and can lead to complications, it is important to assess the accuracy of margins resulting from the use of a new technique. Currently, data regarding the marginal fit of computer-aided design and computer-aided manufacturing (CAD-CAM) technology to fabricate a complete gold crown (CGC) from a castable acrylate resin polymer block are lacking.

PURPOSE

The purpose of this in vitro study was to compare marginal discrepancy widths of CGCs fabricated by using either conventional hand waxing or acrylate resin polymer blocks generated by using CAD-CAM technology.

MATERIAL AND METHODS

A plastic model of a first mandibular molar was prepared by using a 1-mm, rounded chamfer margin on the entire circumference of the tooth. The master die was duplicated 30 times, and 15 wax patterns were fabricated by using a manual waxing technique, and 15 were fabricated by using CAD-CAM technology. All patterns were invested and cast, and resulting CGCs were cemented on their respective die by using resin-modified glass ionomer cement. The specimens were then embedded in acrylic resin and sectioned buccolingually. The buccal and lingual marginal discrepancies of each sectioned portion were measured by using microscopy at ×50 magnification. Data were subjected to repeated measures 2-way ANOVA, by using the Tukey post hoc pairwise comparison test (α=.05).

RESULTS

The factor of "technique" had no significant influence on marginal discrepancy measurement (P=.431), but a significant effect of "margin location" (P=.019) was noted. The confounding combination of factors was found to be significantly lower marginal discrepancy dimensions of the lingual margin discrepancy than on the buccal side by using CAD-CAM technology.

CONCLUSIONS

The marginal discrepancy of CAD-CAM acrylate resin crowns was not significantly different from those made with a conventional manual method; however, lingual margin discrepancies present from CAD-CAM-prepared crowns were significantly less than those measured on the respective buccal surface.

Evaluation of Two Protocols to Measure the Accuracy of Fixed Dental Prostheses: An In Vitro Study

PURPOSE

The aim of this in vitro study was to compare two measurement protocols of the internal and marginal fit of three-unit zirconia fixed dental prostheses (FDPs).

MATERIALS AND METHODS

Forty-four FDPs were fabricated for standardized dies by two laboratory CAD/CAM systems: Cercon (n = 22) and Ceramill (n = 22). The fitting was tested using a replica technique (RT = technique 1) with a light-body silicone stabilized with heavy-body material. After producing the replicas, cross-sections were made in the buccolingual and mesiodistal directions. FDPs were cemented on definitive dies, embedded, and sectioned (CST = technique 2). The marginal and internal fits were measured under an optical microscope at 50x magnification with a special software program. Data evaluation was performed according to prior studies at a level of significance of 5%.

RESULTS

The mean internal gap width was 51 ± 36 μm for the RT and 52 ± 35 μm for the cross-section technique (CST) (p = 0.74). The mean marginal gap width was 27 ± 18 μm for RT and 30 ± 19 μm for CST (p = 0.19). Statistical tests showed no significant differences (p > 0.05).

CONCLUSIONS

Both techniques can be used for fit evaluation; however, the noninvasive RT is suitable for clinical use.

Comparison of the fit of cast gold crowns fabricated from the digital and the conventional impression techniques

PURPOSE

The purpose of this study was to compare the fit of cast gold crowns fabricated from the conventional and the digital impression technique.

MATERIALS AND METHODS

Artificial tooth in a master model and abutment teeth in ten patients were restored with cast gold crowns fabricated from the digital and the conventional impression technique. The forty silicone replicas were cut in three sections; each section was evaluated in nine points. The measurement was carried out by using a measuring microscope and I-Soultion. Data from the silicone replica were analyzed and all tests were performed with α-level of 0.05.

RESULTS

1. The average gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly. 2. In marginal and internal axial gap of cast gold crowns, no statistical differences were found between the two impression techniques. 3. The internal occlusal gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly.

CONCLUSION

Both prostheses presented clinically acceptable results with comparing the fit. The prostheses fabricated from the digital impression technique showed more gaps, in respect of occlusal surface.

The effect of veneering on the marginal fit of CAD/CAM-generated, copy-milled, and cast metal copings

OBJECTIVE

This in vitro study investigated the marginal fit of metal and zirconia copings before and after veneering on dies with shoulder/chamfer (s/c) finish lines.

MATERIALS AND METHODS

Using CAD/CAM, ten (n = 10) each s/c zirconia (NZ) copings and ten (n = 10) each s/c metal (MM) copings were generated. As controls, ten (n = 10) each s/c zirconia copings were copy-milled (ZZ) and ten (n = 10) each s/c metal copings were cast (CC). The vertical marginal discrepancy of the copings was measured at 20 predefined spots of the circular shoulder and chamfer finish lines in microns (μm) before and after a first and a second veneering firing using a stereomicroscope at ×40 magnification. Data were statistically analyzed, and the comparisons of CAD/CAM-milled (NZ, MM), copy-milled (ZZ), and cast (CC) copings before and after veneering were made at a significance level of p < 0.05.

RESULTS

Gap width at s/c finish lines of ZZ was (91 ± 11/100 ± 28) and increased significantly (109 ± 21/141 ± 18) after the first firing (ZZ1). NZ showed significantly smaller gaps than ZZ (36 ± 6/46 ± 12) and (NZ1) after the first firing (61 ± 16/71 ± 29). Gap widths of CC groups (36 ± 8/25 ± 4) were not significantly different from NZ but were significantly lower after the (CC1) first veneering firing (40 ± 8/42 ± 7). MM copings showed gap values similar to NZ. Second firings did not significantly increase gaps in all groups except ZZ2 of chamfer finish line.

CONCLUSION

Veneering increased the marginal gap width of copings.

CLINICAL RELEVANCE

Within the limits of this in vitro study, aesthetic ceramic veneering of CAD/CAM-generated copings caused a statistically significant but tolerable loss of marginal fit precision.

Marginal and internal fit of cobalt-chromium copings fabricated using the conventional and the direct metal laser sintering techniques: A comparative in vitro study

Background and Objectives:

This in vitro study seeks to evaluate and compare the marginal and internal fit of cobalt-chromium copings fabricated using the conventional and direct metal laser sintering (DMLS) techniques.

Methods:

A master model of a prepared molar tooth was made using cobalt-chromium alloy. Silicone impression of the master model was made and thirty standardized working models were then produced; twenty working models for conventional lost-wax technique and ten working models for DMLS technique. A total of twenty metal copings were fabricated using two different production techniques: conventional lost-wax method and DMLS; ten samples in each group. The conventional and DMLS copings were cemented to the working models using glass ionomer cement. Marginal gap of the copings were measured at predetermined four points. The die with the cemented copings are standardized-sectioned with a heavy duty lathe. Then, each sectioned samples were analyzed for the internal gap between the die and the metal coping using a metallurgical microscope. Digital photographs were taken at ×50 magnification and analyzed using measurement software. Statistical analysis was done by unpaired t-test and analysis of variance (ANOVA).

Results:

The results of this study reveal that no significant difference was present in the marginal gap of conventional and DMLS copings (P > 0.05) by means of ANOVA. The mean values of internal gap of DMLS copings were significantly greater than that of conventional copings (P < 0.05).

Conclusions:

Within the limitations of this in vitro study, it was concluded that the internal fit of conventional copings was superior to that of the DMLS copings. Marginal fit of the copings fabricated by two different techniques had no significant difference.

Accuracy of the One-Stage and Two-Stage Impression Techniques: A Comparative Analysis

Introduction. One of the main steps of impression is the selection and preparation of an appropriate tray. Hence, the present study aimed to analyze and compare the accuracy of one- and two-stage impression techniques. Materials and Methods. A resin laboratory-made model, as the first molar, was prepared by standard method for full crowns with processed preparation finish line of 1 mm depth and convergence angle of 3-4°. Impression was made 20 times with one-stage technique and 20 times with two-stage technique using an appropriate tray. To measure the marginal gap, the distance between the restoration margin and preparation finish line of plaster dies was vertically determined in mid mesial, distal, buccal, and lingual (MDBL) regions by a stereomicroscope using a standard method. Results. The results of independent test showed that the mean value of the marginal gap obtained by one-stage impression technique was higher than that of two-stage impression technique. Further, there was no significant difference between one- and two-stage impression techniques in mid buccal region, but a significant difference was reported between the two impression techniques in MDL regions and in general. Conclusion. The findings of the present study indicated higher accuracy for two-stage impression technique than for the one-stage impression technique.

Comparison of the fit accuracy of zirconia-based prostheses generated by two CAD/CAM systems

PURPOSE

The purposes of this study are to evaluate the internal and marginal adaptation of two widely used CAD/CAM systems and to study the effect of porcelain press veneering process on the prosthesis adaptation.

MATERIALS AND METHODS

Molar of a lower jaw typodont resin model was prepared by adjusting a 1.0 mm circumferential chamfer, an occlusal reduction of 2.0 mm, and a 5° convergence angle and was duplicated as an abrasion-resistant master die. The monolithic crowns and copings were fabricated with two different CAD/CAM system-Ceramil and Zirkonzahn systems. Two kinds of non-destructive analysis methods are used in this study. First, weight technique was used to determine the overall fitting accuracy. And, to evaluate internal and marginal fit of specific part, replica technique procedures were performed.

RESULTS

The silicone weight for the cement space of monolithic crowns and copings manufactured with Ceramil system was significantly higher than that from Zirkonzahn system. This gap might cause the differences in the silicone weight because the prostheses were manufactured according to the recommendation of each system. Marginal discrepancies of copings made with Ceramil system were between 106 and 117 µm and those from Zirkonzahn system were between 111 and 115 µm. Marginal discrepancies of copings made with Ceramil system were between 101 and 131 µm and those from Zirkonzahn system were between 116 and 131 µm.

CONCLUSION

Marginal discrepancy was relatively lower in Ceramil system and internal gap was smaller in Zirkonzahn system. There were significant differences in the internal gap of monolithic crown and coping among the 2 CAD/CAM systems. Marginal discrepancy produced from the 2 CAD/CAM systems were within a reported clinically acceptable range of marginal discrepancy.

Influence of object translucency on the scanning accuracy of a powder-free intraoral scanner: A laboratory study

STATEMENT OF PROBLEM

Limited information is available regarding the influence of object translucency on the scanning accuracy of a powder-free intraoral scanner.

PURPOSE

The purpose of this in vitro study was to evaluate the scanning accuracy of a confocal microscopy principle powder-free intraoral scanner on ceramic copings and to analyze the relationship between scanning accuracy and object translucency.

METHODS

Six slice specimens (12×10 mm) and 6 offset copings (1.00-mm thickness) were made from different translucent homogeneous ceramic blocks (CEREC Blocs, S0-M to S5-M, highest to lowest translucency). The primary sintered zirconia offset coping was produced in the same way as the control. Optical parameters related to the translucency of each slice were measured with a spectrophotometer. Three-dimensional (3D) datasets of the surface morphology of offset copings were obtained by using the intraoral scanner. The same white wax resin bases were used for registration. Quantitative parameters of scanning trueness and precision were measured. One-way ANOVA was used to analyze the values of each parameter among the 6 ceramic blocks. Bivariate correlation was used to analyze the relationships between each parameter of scanning accuracy and translucency (α=.05).

RESULTS

Translucent copings showed a positive 3D bias (S0-M to S5-M: 0.149 ±0.038 mm to 0.068 ±0.020 mm), a narrower collar diameter (Dd=-0.067 mm), larger convergence angle (ΔΦ=2.79 degrees), and larger curvature radius of the internal gingivoaxial corner (Δρ=0.236 mm). The smaller the percentage sum of scattering and absorption, the greater was the occurrence of scanning bias (r=-0.918) and curvature (r=-0.935) decrease.

CONCLUSIONS

Use of the tested powder-free intraoral scanner, higher translucency objects (greater translucency than S1-M/A1C) resulted in lower scanning accuracy and morphological changes. Therefore, more suitable methods of measurement are still required.

Subjective qualitative assessment of the finish line of prosthetic preparations submitted to different finishing instruments

STATEMENT OF PROBLEM

Different instruments have been developed to improve crown finish lines after conventional preparation with diamond rotary instruments. However, more evidence on the effectiveness of these instruments is required.

PURPOSE OF STUDY

The purpose of this in vitro study was to assess the effectiveness of 4 different instruments used for cervical margin finishing in regard to the external line angle (ELA).

MATERIAL AND METHODS

Forty-eight freshly extracted third molar teeth with similar dimensions were conventionally prepared for crowns and randomly allocated into 4 groups (n=12) according to the finishing instrument: hand trimmer (HT), tungsten carbide bur (TCB), ultrasonic instrument (UI), and diamond rotary instrument (DRI) mounted in a contra angle handpiece with reduced speed. Photomicrographs from the margin profiles of each tooth were obtained with scanning electron microscopy (×40) before and after finishing procedures. The images were qualitatively analyzed (scores 1-4) by 9 experienced dental professionals. Average results were assessed with the paired t test and repeated measures ANOVA followed by Tukey HSD test (α=.05).

RESULTS

HT, TCB, and UI demonstrated no significant differences between unfinished and finished mean ELA scores. DRI was the only group to demonstrate a significantly improved ELA (P<.001). Except for HT in relation to TCB (P=.989), all the other groups demonstrated statistically significant different ELA scores.

CONCLUSION

DRI mounted in a contra angle handpiece was the only finishing instrument capable of significantly improving the ELA, while TCB and UI produced nonsignificant improvement, and HT was detrimental to the ELA.

Influence of Tooth Preparation Design on Fitting Accuracy of CAD-CAM Based Restorations

OBJECTIVE

The purpose of this study was to evaluate the marginal fit of different zirconia and metal frameworks and compare them with each other on different finish line configurations.

MATERIALS AND METHODS

20 stainless steel dies 10 with shoulder and 10 with chamfer finish line including 6 mm preparation height and 3 degree axial angle simulating a 6 degree total occlusal covergence of the prepared tooth were produced. After embedding the each group of die into the arch-shaped acrylic resin blocks, impressions were made using silicone based impression material and 120 casts were prepared subsequently. The dies were divided into six groups each having 20 specimens (10 with shoulder, 10 with chamfer finish line). Group CM consisted of Co-Cr produced by conventional casting procedure, group MM of Co-Cr prepared by metal milling, group LM of Co-Cr prepared by direct laser metal sinterization (DLMS), group ZZ of Zirkonzahn (Zirkonzahn GmbH, Gais, Italy), group LZ of Lava Zirconia (3 M ESPE Dental AG, Seefeld, Germany) and group DZ of DC-Zirkon (DCS Dental AG, Allschwil, Switzerland). Stereomicroscope were used to evaluate the marginal fit of frameworks and marginal gap values obtained from the images were analyzed using Mann-Whitney U Test and Kruskal-Wallis H Test with Bonferroni correction.

RESULTS

The lowest value of marginal gap was identified in the samples from the LZ group and the highest value was identified in those from ZZ in both finish lines. The effect of finish lines was not significant for most groups but CM frameworks with chamfer finish lines and the DZ frameworks with shoulder finish lines showed significantly lower marginal gap values.

CONCLUSION

The marginal gaps of the various tested zirconia and metal framework were within the range of clinical acceptability (120 µm).

CLINICAL SIGNIFICANCE

The results of this in vitro study suggest that margin preparation design and type of zirconia and metal framework materials for various CAD-CAM systems have a significant effect on marginal fit of the resulting restorations. (J Esthet Restor Dent 28:238-246, 2016).

Marginal and internal fit of nano-composite CAD/CAM restorations

Objectives

The purpose of this study was to compare the marginal and internal fit of nano-composite CAD-CAM restorations.

Materials and Methods

A full veneer crown and an mesio-occluso-distal (MOD) inlay cavity, which were prepared on extracted human molars, were used as templates of epoxy resin replicas. The prepared teeth were scanned and CAD-CAM restorations were milled using Lava Ultimate (LU) and experimental nano-composite CAD/CAM blocks (EB) under the same milling parameters. To assess the marginal and internal fit, the restorations were cemented to replicas and were embedded in an acrylic mold for sectioning at 0.5 mm intervals. The measured gap data were pooled according to the block types and measuring points for statistical analysis.

Results

Both the block type and measuring point significantly affected gap values, and their interaction was significant (p = 0.000). In crowns and inlays made from the two blocks, gap values were significantly larger in the occlusal area than in the axial area, while gap values in the marginal area were smallest (p < 0.001). Among the blocks, the restorations milled from EB had a significantly larger gap at all measuring points than those milled from LU (p = 0.000).

Conclusions

The marginal and internal gaps of the two nano-composite CAD/CAM blocks differed according to the measuring points. Among the internal area of the two nano-composite CAD/CAM restorations, occlusal gap data were significantly larger than axial gap data. The EB crowns and inlays had significantly larger gaps than LU restorations.

Evaluation of marginal fit of 2 CAD-CAM anatomic contour zirconia crown systems and lithium disilicate glass-ceramic crown

PURPOSE

This study was to evaluate the marginal fit of two CAD-CAM anatomic contour zirconia crown systems compared to lithium disilicate glass-ceramic crowns.

MATERIALS AND METHODS

Shoulder and deep chamfer margin were formed on each acrylic resin tooth model of a maxillary first premolar. Two CAD-CAM systems (Prettau®Zirconia and ZENOSTAR®ZR translucent) and lithium disilicate glass ceramic (IPS e.max®press) crowns were made (n=16). Each crown was bonded to stone dies with resin cement (Rely X Unicem). Marginal gap and absolute marginal discrepancy of crowns were measured using a light microscope equipped with a digital camera (Leica DFC295) magnified by a factor of 100. Two-way analysis of variance (ANOVA) and post-hoc Tukey's HSD test were conducted to analyze the significance of crown marginal fit regarding the finish line configuration and the fabrication system.

RESULTS

The mean marginal gap of lithium disilicate glass ceramic crowns (IPS e.max®press) was significantly lower than that of the CAD-CAM anatomic contour zirconia crown system (Prettau®Zirconia) (P<.05). Both fabrication systems and finish line configurations significantly influenced the absolute marginal discrepancy (P<.05).

CONCLUSION

The lithium disilicate glass ceramic crown (IPS e.max®press) had significantly smaller marginal gap than the CAD-CAM anatomic contour zirconia crown system (Prettau®Zirconia). In terms of absolute marginal discrepancy, the CAD-CAM anatomic contour zirconia crown system (ZENOSTAR®ZR translucent) had under-extended margin, whereas the CAD-CAM anatomic contour zirconia crown system (Prettau®Zirconia) and lithium disilicate glass ceramic crowns (IPS e.max®press) had overextended margins.

The effect of various veneering techniques on the marginal fit of zirconia copings

PURPOSE

This study aimed to evaluate the fit of zirconia ceramics before and after veneering, using 3 different veneering processes (layering, press-over, and CAD-on techniques).

MATERIALS AND METHODS

Thirty standardized zirconia CAD/CAM frameworks were constructed and divided into three groups of 10 each. The first group was veneered using the traditional layering technique. Press-over and CAD-on techniques were used to veneer second and third groups. The marginal gap of specimens was measured before and after veneering process at 18 sites on the master die using a digital microscope. Paired t-test was used to evaluate mean marginal gap changes. One-way ANOVA and post hoc tests were also employed for comparison among 3 groups (α=.05).

RESULTS

Marginal gap of 3 groups was increased after porcelain veneering. The mean marginal gap values after veneering in the layering group (63.06 µm) was higher than press-over (50.64 µm) and CAD-on (51.50 µm) veneered groups (P<.001).

CONCLUSION

Three veneering methods altered the marginal fit of zirconia copings. Conventional layering technique increased the marginal gap of zirconia framework more than pressing and CAD-on techniques. All ceramic crowns made through three different veneering methods revealed clinically acceptable marginal fit.

Gap comparison between single crown and three-unit bridge zirconia substructures

PURPOSE

To compare marginal and internal gaps of zirconia substructure of single crowns with those of three-unit fixed dental prostheses.

MATERIALS AND METHODS

Standardized Co-Cr alloy simulated second premolar and second molar abutments were fabricated and subsequently duplicated into type-III dental stone for working casts. After that, all zirconia substructures were made using Lava™ system. Marginal and internal gaps were measured in 2 planes (mesial-distal plane and buccal-palatal plane) at 5 locations: marginal opening (MO), chamfer area (CA), axial wall (AW), cusp tip (CT) and mid-occlusal (OA) using Replica technique.

RESULTS

There were significant differences between gaps at all locations. The mean ± SD of marginal gap in premolar was 43.6 ± 0.4 µm and 46.5 ± 0.5 µm for single crown and 3-unit bridge substructure respectively. For molar substructure the mean ± SD of marginal gap was 48.5 ± 0.4 µm and 52.6 ± 0.4 µm for single crown and 3-unit bridge respectively. The largest gaps were found at the occlusal area, which was 150.5 ± 0.5 µm and 154.5 ± 0.4 µm for single and 3-unit bridge premolar substructures respectively and 146.5 ± 0.4 µm and 211.5 ± 0.4 µm for single and 3-unit bridge molar substructure respectively.

CONCLUSION

Independent-samples t-test showed significant differences of gap in zirconia substructure between single crowns and three-unit bridge (P<.001). Therefore, the span length has the effect on the fit of zirconia substructure that is fabricated using CAD/CAM technique especially at the occlusal area.

Full-arch prostheses from translucent zirconia: accuracy of fit

OBJECTIVES

The aim of this study was to evaluate the marginal and internal fit of single crowns, compared to 14-unit frameworks made of translucent yttria-stabilized zirconia. We hypothesized that there is an influence of the type of restoration on the marginal and internal fit.

METHODS

Eight teeth (FDI locations 17, 15, 13, 11, 21, 23, 25 and 27) of a typodont maxillary model were provided with a chamfer preparation to accommodate a 14-unit prosthesis or four single crowns (SCs). Ten 14-unit fixed dental prostheses (FDPs) and 40 single crowns were fabricated using a computer aided design (CAD)/computer aided manufacturing (CAM) system with pre-sintered translucent yttria-stabilized zirconia blanks. The restorations were cemented onto twenty master dies, which were sectioned into four pieces each. Then, the marginal and internal fits were examined using a binocular microscope. In order to detect the differences between the two types of restorations a non-parameteric test (Mann-Whitney-U) was carried out; to detect differences between the abutment teeth and the abutment surfaces non-parametric tests (Kruskal-Wallis) and pairwise post hoc analyses (Mann-Whitney-U) were performed after testing data for normal distribution (method according to Shapiro-Wilk). Level of significance was set at 5%.

RESULTS

The mean (SD) marginal opening gap dimensions were 18 μm (14) for the single crowns and 29 μm (27) for the 14-unit FDPs (p<0.001). Abutment 21 of the FDPs showed statistical differences concerning the location of the teeth in both marginal and internal fit (p<0.001). The measured gaps (types I-IV) revealed statistical differences between all types, when comparing SCs to the FDPs (p<0.001).

SIGNIFICANCE

Single crowns showed significantly better accuracy of fit, compared to the 14-unit FDPs. However, both restorations showed clinically acceptable marginal and internal fit.

Clinical marginal and internal adaptation of CAD/CAM milling, laser sintering, and cast metal ceramic crowns

STATEMENT OF PROBLEM

Metal ceramic crowns are widely used in clinical practice, but comparisons of the clinical adaptation of restorations made with different processing techniques are lacking.

PURPOSE

The purpose of this study was to compare the clinical marginal and internal adaptation of metal ceramic crowns fabricated with 3 different techniques: computer-aided design and computer-aided manufacturing (CAD/CAM) milling (CCM), direct metal laser sintering (DMLS), and traditional casting (TC).

MATERIAL AND METHODS

Twenty CCM, 20 DMLS, and 20 TC metal ceramic crowns were fabricated for 42 patients. Before luting the crowns, silicone replicas were obtained to measure marginal gap and internal adaptation that was evaluated at 3 regions: axial wall, axio-occlusal angle, and occlusal surface. Measurements were made with a reflected light binocular stereomicroscope at 20× magnification and analyzed with 1-way analysis of variance (ANOVA) and the Bonferroni post hoc test (α=.05).

RESULTS

The mean marginal gap values were 86.64 μm for CCM, 96.23 μm for DMLS, and 75.92 μm for TC. The means at the axial wall region were 117.5 μm for the CCM group, 139.02 μm for the DMLS group, and 121.38 μm for the TC group. One-way ANOVA revealed no statistically significant differences among the groups for measurements at the marginal gap (P=.082) and the axial wall region (P=.114). The means at the axio-occlusal region were 142.1 μm for CCM, 188.12 μm for DMLS, and 140.63 μm for TC, and those at the occlusal surface region were 265.73 μm for CCM, 290.39 μm for DMLS, and 201.09 μm for TC. The mean values of group DMLS were significantly higher at the axio-occlusal region and the occlusal surface region than those of other groups (P<.05).

CONCLUSIONS

CCM, DMLS and TC metal ceramic crowns performed similarly in terms of clinical marginal and axial wall adaptation. The cement film thickness at the occlusal region and axio-occlusal region were higher for DMLS crowns.

Influence of oscillating and rotary cutting instruments with electric and turbine handpieces on tooth preparation surfaces

STATEMENT OF THE PROBLEM

Rotary and nonrotary cutting instruments are used to produce specific characteristics on the axial and marginal surfaces of teeth being prepared for fixed restorations. Oscillating instruments have been suggested for tooth preparation, but no comparative surface roughness data are available.

PURPOSE

To compare the surface roughness of simulated tooth preparations produced by oscillating instruments versus rotary cutting instruments with turbine and electric handpieces.

MATERIAL AND METHODS

Different grit rotary cutting instruments were used to prepare Macor specimens (n=36) with 2 handpieces. The surface roughness obtained with rotary cutting instruments was compared with that produced by oscillating cutting instruments. The instruments used were as follows: coarse, then fine-grit rotary cutting instruments with a turbine (group CFT) or an electric handpiece (group CFE); coarse, then medium-grit rotary cutting instruments with a turbine (group CMT) or an electric handpiece (group CME); coarse-grit rotary cutting instruments with a turbine handpiece and oscillating instruments at a low-power (group CSL) or high-power setting (group CSH). A custom testing apparatus was used to test all instruments. The average roughness was measured for each specimen with a 3-dimensional optical surface profiler and compared with 1-way ANOVA and the Tukey honestly significant difference post hoc test for multiple comparisons (α=.05).

RESULTS

Oscillating cutting instruments produced surface roughness values similar to those produced by similar grit rotary cutting instruments with a turbine handpiece. The electric handpiece produced smoother surfaces than the turbine regardless of rotary cutting instrument grit.

CONCLUSION

Rotary cutting instruments with electric handpieces produced the smoothest surface, whereas the same instruments used with a turbine and oscillating instruments achieved similar surface roughness.

Fit of 4-unit FDPs made of zirconia and CoCr-alloy after chairside and labside digitalization--a laboratory study

OBJECTIVES

To analyse the marginal fit of 4-unit fixed dental prostheses (FDPs) and the accuracy of three-dimensional cast-datasets using both approaches to Computer Aided Design (CAD)/Computer Aided Manufacturing (CAM): direct and indirect digitalization.

METHODS

A titanium model of a 4-unit FDP was digitized by an intraoral scanning device (iTero, Align Technology, Carlstadt, US; DD, n=12). Additionally 12 conventional impressions were taken and referring master casts were digitized by a laboratory scanner (CS2, Straumann, Basel, Switzerland; ID, n=12). Frameworks were fabricated (CARES CADCAM GmbH, Straumann, Markkleeberg, Germany) from base metal alloy (coron, Straumann; DD-C: n=12; ID-C: n=12) and zirconia (zerion, Straumann; DD-Z: n=12; ID-Z: n=12) from the same datasets. The marginal fit of the resulting frameworks and the accuracy of the underlying datasets from DD and ID were evaluated. Data were analyzed by unpaired two sample Student's t-test with Levene-test (p<0.05).

RESULTS

Frameworks from group DD-C showed significantly better marginal fit than ID-C (DD-C: 56.90±27.37 μm, ID-C: 90.64±90.81 μm). For zirconia frameworks no differences between both digitalization methods (DD-Z: 127.23±66.87 μm, ID-Z: 141.08±193.17 μm) could be observed. Base metal alloy frameworks exhibited significantly better marginal fit than zirconia frameworks (DD: p<0.001; ID: p=0.022). Regarding the accuracy group DD showed significantly higher "trueness" than ID.

SIGNIFICANCE

Direct and indirect digitalization lead to clinically acceptable marginal fit of 4-unit FDPs from base metal alloy and zirconia. Higher accuracy of datasets from DD leads to better marginal fit of frameworks from base metal alloy but not for ones from zirconia.