An evaluation of marginal fit of three-unit fixed dental prostheses fabricated by direct metal laser sintering system

Evaluating the Marginal and Internal Discrepancy of Nickel-Chrome Copings Made on Fixed Partial Denture Implants with Conventional and 3D Printing Techniques

AIM

This study aimed to evaluate the marginal and internal discrepancy of nickel-chrome (Ni-Cr) copings made on implant bridges with conventional and 3D printing techniques.

MATERIALS AND METHODS

30 three-unit Ni-Cr FDPs (60 copings) were made by 3D-printing technique (PolyJet group), lost-wax method with die spacer technique (die spacer group), and lost-wax method with burn-out the cap (burn-out cap group). Then, the frames obtained from the three methods were checked to examine the marginal discrepancy by stereomicroscope after preparation and polishing. The silicon replica method was used to investigate the internal discrepancy at 6 points (buccal portion of occlusal surface, lingual portion of occlusal surface, middle area of the axial surface in the lingual, middle area of the axial surface in the buccal, cervico-buccal area, and cervico-lingual area). Kolmogorov-Smirnov test was performed first to estimate the normality of data distribution. A one-way ANOVA and post hoc Tukey test were done for comparing marginal and internal discrepancies between groups. The significant level was considered p < 0.05.

RESULTS

The mean ± standard deviation of marginal discrepancy in the PolyJet group, die spacer group, and burn-out cap group was 37.9 ± 15, 68.8 ± 31.8 and 42.7 ± 3.6 µm for buccal margins and 40.4 ± 12.3, 64 ± 21.7, and 42.4 ± 2.1 µm for lingual margins, respectively. The means of buccal and lingual marginal discrepancy in the burn-out cap group and PolyJet group were significantly lower than the die spacer group (p < 0.001). Marginal discrepancy was not statistically different between the burn-out cap group and the PolyJet group. The mean ± standard deviation of overall internal discrepancy in the PolyJet group, die spacer group, and burn-out cap group was 64.6 ± 3.7, 72 ± 22.2, and 58.7 ± 2 µm, respectively. There was a significant difference between the mean of internal discrepancy between three groups (p = 0.001). The mean of internal discrepancy of the burn-out cap group was significantly lower than the die spacer group (p = 0.001) and PolyJet group (p = 0.005). Internal discrepancy was not significantly different between the PolyJet group and the die spacer group (p = 0.168).

CONCLUSION

The marginal and internal gap rates of the three groups were within clinically acceptable limits. The 3D printing technique and lost-wax method with burn-out the cap had the lowest buccal and lingual marginal discrepancies. The burn-out cap method had better fitness and less internal discrepancy than 3D printing and die spacer groups.

CLINICAL SIGNIFICANCE

Lower marginal discrepancy of copings fabricated by using 3D printed patterns may improve clinical success of implant restoration. How to cite this article: Ziaei M, Bajoghli F, Sabouhi M, et al. Evaluating the Marginal and Internal Discrepancy of Nickel-Chrome Copings Made on Fixed Partial Denture Implants with Conventional and 3D Printing Techniques. J Contemp Dent Pract 2023;24(11):826-833.

The effect of repeated porcelain firings on the marginal fit of millable and conventional casting alloys

The durability of dental restorations is highly determined by an accurate marginal fit, which is in turn affected by the high temperature of porcelain firing. Information is inadequate about the marginal adaptation of metal-ceramic restorations fabricated by soft metal milling technologies after repeated firings. This study aimed to compare the effect of repeated ceramic firings on the marginal fit of copings fabricated from cobalt-chromium through soft metal milling and a conventional nickel-chromium casting alloy. A single standard brass die was designed, machined, and scanned, based on which, 20 frameworks were designed and fabricated through either soft metal milling or conventional casting (n = 10 per group) and porcelain veneered. The vertical marginal fit of the metal copings was measured after 3, 5, and 7 firing cycles by using a digital microscope on 16 points around the finish line of the metal die at ×80 magnification. The data were analyzed through repeated measures ANOVA and independent t-test (α = 0.05). The marginal fit of neither metal group was significantly affected by the number of firing cycles (P = 0.747). However, the marginal discrepancy was statistically lower in the soft metal milling group than that in the casting group (P<0.001). Repeated porcelain firings did not significantly affect the marginal fit of either alloy and remained within the clinically acceptable range after firings. However, the milled alloy had superior marginal fit regardless of the number of firing cycles.

In-Vitro Investigation of Marginal Adaptation and Fracture Resistance of Resin Matrix Ceramic Endo-Crown Restorations

The aim of this study was to evaluate the fracture resistance and marginal adaptation of endo-crown restorations produced from different resin-matrix ceramics (RMS) and the effects of these materials on marginal adaptation and fracture resistance. Three frasaco models were used by preparing (first) premolar teeth in three different margin preparations: butt-joint, heavy chamfer and shoulder. Each group was further divided into four subgroups according to the type of restorative material used: Ambarino High Class (AHC), Voco Grandio (VG), Brilliant Crios (BC) and Shofu (S) (n = 30). Master models were obtained using an extraoral scanner and fabricated with a milling machine. Marginal gap evaluation was performed with a silicon replica technique using a stereomicroscope. Replicas of the models (n = 120) were produced with epoxy resin. The fracture resistance of the restorations was recorded using a universal testing machine. The data were statistically analyzed using two-way ANOVA, and a t-test was applied for each group. Tukey's post-hoc test was performed to compare significant differences (p ≤ 0.05). The highest marginal gap was observed in VG, and the best marginal adaptation and the highest fracture resistance were found in BC. The lowest fracture resistance in Butt-joint preparation design was found in S. In addition, the lowest fracture resistance value in the heavy chamfer preparation design was found in AHC. The heavy shoulder preparation design displayed the highest fracture resistance values for all materials.

Marginal Misfit of 3D-Printed (Selective Laser Sintered), CAD-CAM and Lost Wax Technique Cobalt Chromium Copings with Shoulder and Chamfer Finish Lines: An In-Vitro Study

Background and Objectives: The aim was to compare the Misfit of 3D-Printed, Selective laser melting (SLM), milled (Computer aided design-Computer aided manufacture CAD-CAM) and Lost wax technique (LWT) fabricated Cobalt chromium (CoCr) alloy copings on shoulder (SH), radial shoulder (R-SH) and chamfer (CH) finish line configuration. Materials and Methods: Ninety resin, second maxillary premolar teeth were prepared for metal-ceramic crowns, equally divided into (n = 30) SH, R-SH and CH margin preparations. For each preparation design (SH, R-SH and CH), CoCr copings were prepared using SLM, CAD-CAM and LWT. This resulted in nine study groups with 10 CoCr copings each. The marginal misfit of specimens was assessed with a high-resolution digital microscope. Misfit was evaluated in vertical and horizontal dimensions in μm. Data were analyzed using ANOVA and a post hoc multiple comparisons test. Results: For vertical misfit, the highest was observed in SLM samples with chamfer margin (167.96 ± 24.1), and the least was shown by CAD-CAM samples with radial shoulder (58.8 ± 12.53). CAD-CAM and shoulder margins showed the least vertical misfit. For horizontal misfit, the maximum was observed in SLM samples with shoulder margin (137.94 ± 37.85) and the least by LWT samples with chamfer (89.38 ± 14.81). Chamfer margins and LWT samples showed the least horizontal misfit among the group samples. Fabrication technique and finish line design play a critical role in reducing the marginal misfit of CoCr copings. Conclusions: For vertical misfit, SLM copings showed poor outcomes compared to CAD-CAM specimens, however comparable outcomes to Cast specimens. SLM copings showed comparable horizontal misfit outcomes to CAD-CAM specimens and low misfit compared to Cast copings, respectively. Vertical misfit was low with shoulder margins, and horizontal misfit was better with chamfer marginal configuration.

The Impact of Sintering Technology and Milling Technology on Fitting Titanium Crowns to Abutment Teeth-In Vitro Studies

INTRODUCTION

The aim of the study is to evaluate the marginal and internal fit of titanium alloy (Ti6Al4V) crowns using the Selective Laser Melting (SLM) method and CAD/CAM milling.

MATERIALS AND METHODS

The research materials are abutment teeth and prosthetic crowns. The method is based on scanning the abutments and the interior of the substructures, creating their 3D models, using the program for comparison, and determining error maps of fitting crowns to the reference models, in the form of positive and negative deviations. Adding the deviations gives information about the tightness of the crowns. The Shapiro-Wilk test and the one-way ANOVA analysis were performed. The level of significance was p = 0.05.

RESULTS

The crowns made in SLM, a slightly better internal fit was found than for milled crowns, as well as a comparable marginal fit. The mean deviations for the sintering were the values [mm]: -0.039 and +0.107 for tooth 15 and -0.033 and +0.091 for tooth 36, and for the milling -0.048 and +0.110 for tooth 15 and -0.038 and +0.096 and for tooth 36.

CONCLUSION

Based on the research conducted and the experience in therapeutic procedures, it can be indicated that the fitting of titanium alloy crowns in SLM and milling meets the clinical requirements. To evaluate the technology, a method was developed that determines the accuracy of mapping the shape of the tooth abutments in the crown substructures for the individual conditions of the patient.

Effect of full arch two scanning techniques on the accuracy of overdenture conventional and CAD/CAM Co-Cr bars

This work evaluates the internal and marginal adaptation of implant-assisted overdenture cobalt–chromium (Co–Cr) bars manufactured using conventional as well as CAD/CAM subtractive and selective laser melting (SLM) utilizing two scanning techniques. Methods: An edentulous study model containing four dental implants placed at teeth sites 36, 33, 43, and 46 was used. The study cast was scanned and compared to the virtual casts developed from two scanning techniques, straight and zigzag motion, using the in silico superimposition process. Then, conventional techniques were used to produce full-arch bars that were compared to the bars fabricated using the two scanning techniques and CAD/CAM subtractive and additive techniques. Results: The conventional impression and casting techniques had the smallest marginal gap among the groups (P-value < 0.05). The CAD/CAM subtractive milling techniques in groups II and III had significantly smaller marginal gaps than SLM technique used in groups IV and V (P-value < 0.05). The analysis of the internal gap within each group showed statistically significant differences between different implant sites in all groups (P-value < 0.001), except when using the conventional impression and casting techniques in group I (P-value = 0.20). Conclusion: The conventional impression and fabrication techniques were better than the digital impression and CAD/CAM subtractive and additive techniques for the fabrication of full-arch bars. However, both straight and zigzag scanning techniques and the CAD/CAM subtractive technique had marginal and internal gaps that were within clinically accepted ranges, and the SLM was found to be unsuitable for long-span framework fabrication with either scanning technique used.

Accuracy of CAD-CAM milling versus conventional lost-wax casting for single metal copings: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Information comparing the marginal and internal adaptation of single metal copings fabricated via computer-aided design and computer-aided manufacturing (CAD-CAM) milling and lost-wax casting is insufficient.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the adaptation of single metal copings fabricated via CAD-CAM milling to that of copings fabricated via lost-wax casting and to identify factors that influenced their accuracy.

MATERIAL AND METHODS

Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, Elsevier ScienceDirect, PubMed, Cochrane Library, SpringerLink, and Wiley online databases were searched to select qualified articles, which were assessed by the methodological items for nonrandomized studies (MINORS) criteria. The data on the mean absolute marginal gap, marginal gap, axial gap, occlusal gap, and internal gap values of single metal copings fabricated via CAD-CAM milling and lost-wax casting were extracted, and meta-analysis and meta-regression were used with R software (α=.05) and random-effects models to estimate differences and homogeneity between the 2 methods.

RESULTS

For the single metal copings, lost-wax casting and CAD-CAM milling led to similar marginal and internal accuracies, but lost-wax casting led to better absolute marginal gap values. For the cast copings, Ni-Cr alloy (92.8 μm) and noble alloy (51.5 μm) led to the largest and smallest marginal gaps, respectively, (P=.005). For milled copings, the noble alloy led to the smallest marginal gap (19.1 μm), and Co-Cr alloy to the largest (76.2 μm) (P=.012). Soft milling led to a more accurate marginal gap (41.4 μm) than hard milling (66.1 μm) (P=.04).

CONCLUSIONS

When CAD-CAM milling was used to fabricate single metal copings, no advantage in precision was found compared with lost-wax casting, and single metal copings cast from handmade conventional wax patterns had better marginal adaptation than those fabricated via CAD-CAM milling. Noble metal copings had improved marginal accuracy than base metal copings for both the casting and milling methods. Single copings fabricated via soft milling from unsintered metal blocks had more accurate marginal adaption than copings fabricated via hard milling.

Does cad software affect the marginal and internal fit of milled full ceramic crowns?

Although the effects of different intraoral scanners, model scanners, and CAM units on the marginal and internal fitting of restorations have been investigated, the effects of CAD software in particular has not been evaluated. The marginal and internal fit of indirect restorations may vary according to the CAD software used, even when using the same intraoral scanner and milling machine. The purpose of this study was to evaluate the marginal and internal fit of milled full ceramic crowns designed with three different CAD systems. Eleven typodont maxillary first premolar teeth were prepared and scanned using a 3Shape TRIOS Intraoral Dental Scanner. The obtained STL scan data were exported and used to design a full crown using three different CAD systems (CEREC, KaVo, and Planmeca). An independent milling unit was used to manufacture the crowns for each group (n = 11). The marginal and internal fit were evaluated for each restoration using 2D and 3D micro-CT analysis. For 2D analysis, 18 measurements for each sample were made, covering the marginal (Marginal Gap Buccal (MG-A), Marginal Gap Palatinal (MG-B), Finish Line Buccal (FL-A), Finish Line Palatinal (FA-B)) and internal fit locations (Axial Wall Buccal (AW-A), Axial Wall Palatinal (AW-B), Lingual Cusp (LC), Buccal Cusp (BC), and Occlusal Central Fossa (OCF)). Statistical analyses were performed using Open Source R Statistical Software (α = 0.05) The results of Duncan's multiple range test showed that the values for the marginal measurement points MG-A, MG-B, FL-A, and FL-B in the Planmeca group were significantly higher than the values obtained in the CEREC and KaVo groups (p < 0.05). In AW1, values of the CEREC group were found to be higher than those of the KaVo and Planmeca groups (p < 0.05). CAD software showed an effect on the marginal fit values of crowns whereas no significant difference was observed in terms of the internal fit, except for a single measurement point made from the buccal direction.

Applications of three-dimensional printers in prosthetic dentistry

This narrative review aims to provide an overview of recent studies and case reports on three-dimensional (3D) printing, and to verify the applicability of 3D printers in the field of dental prostheses. This review was performed by conducting a search of PubMed. The clinical application of fabricating a prosthesis made with cobalt-chromium is considered possible depending on the material and hardware of the 3D printer. However, it is currently difficult to assess the clinical use of 3D-printed zirconia crowns. Further research is required, such as verification of materials used, margin morphology, and hardware. Clinically acceptable results have been reported for patterns using 3D printers. Interim restorations made using a 3D printer have been reported with good results that are considered clinically usable. Dentures made with 3D printers need further verification in terms of strength and deformation. Custom trays made with 3D printers are clinically useful, however, issues remain with design time and effort. Although several studies have reported the usefulness of 3D printers, further verification is required since 3D printers are still considered new technology.

Effect of Biomedical Materials in the Implementation of a Long and Healthy Life Policy

This paper is divided into seven main parts. Its purpose is to review the literature to demonstrate the importance of developing bioengineering and global production of biomaterials to care for the level of healthcare in the world. First, the general description of health as a universal human value and assumptions of a long and healthy life policy is presented. The ethical aspects of the mission of medical doctors and dentists were emphasized. The coronavirus, COVID-19, pandemic has had a significant impact on health issues, determining the world’s health situation. The scope of the diseases is given, and specific methods of their prevention are discussed. The next part focuses on bioengineering issues, mainly medical engineering and dental engineering, and the need for doctors to use technical solutions supporting medicine and dentistry, taking into account the current stage Industry 4.0 of the industrial revolution. The concept of Dentistry 4.0 was generally presented, and a general Bioengineering 4.0 approach was suggested. The basics of production management and the quality loop of the product life cycle were analyzed. The general classification of medical devices and biomedical materials necessary for their production was presented. The paper contains an analysis of the synthesis and characterization of biomedical materials supporting medicine and dentistry, emphasizing additive manufacturing methods. Numerous examples of clinical applications supported considerations regarding biomedical materials. The economic conditions for implementing various biomedical materials groups were supported by forecasts for developing global markets for biomaterials, regenerative medicine, and tissue engineering. In the seventh part, recapitulation and final remarks against the background of historical retrospection, it was emphasized that the technological processes of production and processing of biomedical materials and the systematic increase in their global production are a determinant of the implementation of a long and healthy policy.

Novel CAD-CAM zirconia coping design to enhance the aesthetics and strength for anterior PLZ crowns

BACKGROUND

The aesthetics and strength of anterior porcelain layered zirconia (PLZ) crowns are mainly affected by the zirconia (Zr) coping design. There is a need for a modified design to enhance aesthetics with strength.

OBJECTIVES

The purpose of this study was to compare the fracture resistance of anterior PLZ crowns having modified CAD-CAM Zr coping designs (in terms of thickness and marginal collar designs) with standard Zr copings.

METHODS

Fifty PLZ crowns were fabricated and divided into two groups: Gr 1: Standard Zr Coping (SZC) (control gr) with 0.5 mm thickness (Facial-F, Mesial-M, Distal-D, incisal-I, and Palatal-P) without a collar; Gr 2: Collar Zr Coping (CZC) (test gr) with 2.5 mm collar height on M, D, P and 0.2 mm F and variable facial wall thickness. Subgroups: Gr 2a: (CZC-0.5 mm) facial wall thickness 0.5 mm; Gr 2b: (CZC-0.4 mm) facial wall thickness 0.4 mm; Gr 2c: (CZC-0.3 mm) facial wall thickness 0.3 mm; Gr 2d: (CZC-0.2 mm) facial wall thickness 0.2 mm. The fracture load was determined and analysed using One-way ANOVA and Dunnet test.

RESULTS

The minimum fracture load was 927.36 ± 127.80 N observed for Gr 2c (CZC at 0.3 mm) while the maximum fracture load was 1373.61 ± 146.54 N observed for Gr 2a (CZC at 0.5 mm). A highly significant difference in mean fracture load among various Zr coping groups (p< 0.001) was determined.

CONCLUSIONS

Novel Zr coping design for anterior PLZ crowns can provide better aesthetics with strength. Reducing the thickness of Zr coping in the aesthetic zone to 0.2 mm and providing a modified collar design (2.5 mm collar height on M, D, P, and 0.2 mm F) would provide strength without jeopardizing aesthetics.

Corrosion Resistance of Cr–Co Alloys Subjected to Porcelain Firing Heat Treatment—In Vitro Study

The procedure of ceramics fusion to cobalt–chromium (Co–Cr) base dental crowns affects their corrosion behavior and biological tolerance. This study’s purpose was to comparatively evaluate the effect of heat treatment (HT) applicable for dental ceramics firing on the corrosion properties among Co–Cr base alloys fabricated via different methods: casting (CST), milling soft metal and post sintering (MSM), and selective laser melting (SLM). All specimens were subjected to a heat treatment corresponding to a full firing schedule. The microstructure and elemental composition of oxidized surfaces were investigated by scanning electron microscopy and energy dispersive spectroscopy. Corrosion properties were examined by electrochemical potentiodynamic polarization tests. The values of jcorr, Ecorr, Rp, and breakdown potential Ebr were estimated. The oxide layers formed during the HT process corresponded to the composition of the original alloys’ structure. Among the thermal treated alloys, SLM showed the highest corrosion resistance, followed by the MSM and CST. This may be attributed to uniform distribution of alloying elements in homogenous structure and to the reduced porosity, which enhances corrosion resistance and decreases the risk of crevice corrosion. The overall corrosion behavior was strongly influenced by the segregation of alloying elements in the microstructure, thus, is directly determined by the manufacturing method.

A comparison of the passive fit of a 3-unit implant-supported fixed partial denture fabricated by lost-wax casting, milling soft metal blocks, or direct metal laser sintering: An in vitro study

STATEMENT OF PROBLEM

Stresses induced by implant-supported prostheses are related to mechanical complications. However, how the manufacturing method affects the generated stresses is unclear.

PURPOSE

The purpose of this in vitro study was to compare the passive fit of 3-unit cobalt-chromium partial prostheses fabricated by using 3 different methods: conventional casting (milled resin with lost-wax method), machined (milling soft metal blocks), or sintered (direct metal laser sintering).

MATERIAL AND METHODS

Thirty 3-unit implant-supported cobalt-chromium fixed prostheses were fabricated, 10 with each method. Four strain gauges were placed over an in vitro resin model with 2 implants in it; 2 gauges were placed above and 2 on the sides to measure the microdeformations caused by placing the structures above the implants in longitudinal flexion, vertical flexion, or torsion, before and after tightening the screws. An inferential analysis was carried out by using a statistical software program, and the Wilcoxon and Kruskal-Wallis tests were applied and then complemented with the Mann-Whitney test for multiple comparisons with the Bonferroni correction (α=.01).

RESULTS

The mean longitudinal deformation, vertical flexion, and torsional deformation values increased after tightening the screws with each of the 3 fabrication methods. Significant differences (P<.01) were found for all 3 methods before and after screw tightening. After screw tightening, the machined structures, followed by sintered structures, and the cast structures (P<.05) had smaller deformations in the X, Y, and Z dimensions. The longitudinal deformation was less in machined structures, and vertical flexion deformation was less in machined and sintered structures than in cast structures (P<.05).

CONCLUSIONS

The deformations registered in the in vitro model increase considerably after screw tightening, which indicates the lack of passive fit. Machined structures provide a better passive fit, followed by sintered structures, and the cast structures had the poorest fit.

Selective laser sintering versus conventional lost-wax casting for single metal copings: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Evidence comparing the marginal and internal fit of single metal copings fabricated via selective laser sintering and conventional lost-wax casting is inadequate.

PURPOSE

The purpose of this systematic review was to compare the fit of single metal copings fabricated via selective laser sintering and lost-wax casting. Moreover, the effects of different variables on fit accuracy were determined.

MATERIAL AND METHODS

Google Scholar, ScienceDirect, SpringerLink, and Wiley databases were searched electronically as well as manually. The mean absolute marginal gap, marginal gap, internal gap, axial gap, and occlusal gap values of single metal copings fabricated via selective laser sintering and lost-wax casting were statistically analyzed to determine and evaluate the factors affecting the fit accuracy (α=.05).

RESULTS

Single metal copings fabricated via selective laser sintering had mean absolute marginal gaps and occlusal gaps similar to those of copings fabricated via lost-wax casting, based on a subgroup meta-analysis of gaps evaluated using stereomicroscopy (P>.05). The fit of single metal copings was not affected by the type of tooth (P>.05). The conventional impression, the indirect digital scan, and the direct digital scan led to similar values of mean axial gap, internal gap, and marginal gap for the copings fabricated via lost-wax casting (P>.05). The indirect and direct digital scans led to similar values of mean axial gap, internal gap, and marginal gap for the copings fabricated via selective laser sintering (P>.05). Printed wax patterns provided significantly smaller mean axial gap values than milled plastic or milled wax patterns for the copings fabricated via lost-wax casting (P<.05). Printed, milled, and conventional wax patterns had similar mean marginal gaps and internal gaps for the copings fabricated via lost-wax casting (P>.05). For single copings fabricated via lost-wax casting, Ni-Cr and Co-Cr had similar mean internal gaps (P>.05).

CONCLUSIONS

No statistically significant differences were found between single metal copings fabricated via selective laser sintering and lost-wax casting. Selective laser sintering can satisfy the clinical requirement for single metal copings.

Influence of Sequential CAD/CAM Milling on the Fitting Accuracy of Titanium Three-Unit Fixed Dental Prostheses

This study investigated the fitting accuracy of titanium alloy fixed dental prostheses (FDP) after sequential CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) fabrication. A three-unit FDP model connecting mandibular second premolars and molars was prepared and scanned to fabricate titanium FDPs by CAD/CAM milling. A total of six FDPs were sequentially milled in one titanium alloy disk using a new set of burs every time (n = 4). The fitting accuracy of FDPs was mesiodistally evaluated by a silicone replica technique and the measurement was triplicated at four different locations: MO (marginal opening), MG (marginal gap), AG (axial gap), and OG (occlusal gap). Data were statistically analyzed using ANOVA and Tukey’s HSD test. The fitting accuracy of PMMA (polymethyl methacrylate) FDPs milled using the worn or new bur were evaluated by the same procedure (n = 6). The mean dimensions of titanium FDP for all measuring positions, except for AG, were significantly increased from the third milling. However, no difference was noted between the first FDP and the second FDP milled with the same set of burs. Severe edge chippings were observed in all milling burs. Detrimental effects of the worn burs on the fitting accuracy were demonstrated in the CAD/CAM-milled PMMA FDP. The results recommend proper changing frequency of cutting burs to achieve the quality of fit and predictable outcomes for dental CAD/CAM prostheses.

Fit Alteration of Presintered Co-Cr and Zirconia Multiple-Unit Prostheses After Ceramic Layering

PURPOSE

The fit alteration after ceramic layering of soft Cobalt-Chromium (Co-Cr) and zirconia is poorly documented. This study compared the marginal and internal fit of presintered Co-Cr and zirconia three-unit fixed dental prostheses before and after ceramic veneering.

MATERIALS AND METHODS

Co-Cr master model was prepared and duplicated 60 times to receive three-unit fixed dental prostheses (FDPs). Sixty dies were prepared, scanned and assigned to 3 groups (n = 20/group), to receive the FDPs made of presintered Co-Cr (CS), presintered zirconia (CZ) and cast Ni-Cr (Wi). Each framework was seated on its specific cast. A replica technique was used for marginal and internal discrepancy measurements in mesiodistal and buccolingual planes. Frameworks were ceramic veneered. Results were compared before and after ceramic layering within each group. Data were analyzed using the Levene, t test, and ANOVA (α = 0.05).

RESULTS

Significant difference was found when gaps were compared within groups for CS and CZ but not for Wi. At the abutments level, significant difference was found for both premolars and molars in the buccolingual planes (p < 0.001). A multiple comparison between materials tested showed significant differences between presintered and cast Ni-Cr. No significant difference was detected between CS and CZ (p = 1.000).

CONCLUSIONS

Although ceramic layering increased the discrepancy for presintered Co-Cr and zirconia, the marginal adaptation remained clinically acceptable.

A Comparative Evaluation of Marginal Accuracy of Co-Cr Metal Copings Fabricated Using Traditional Casting Techniques and Metal Laser Sintering

Aims and objectives

The aim and objective of the study were to determine the amount of marginal discrepancy produced by cobalt-chromium (Co-Cr) copings fabricated using two different fabrication methods, i.e., traditional casting and direct metal laser-sintering (DMLS), and compare the values obtained between each fabrication technique and to evaluate if the fabrication technique can produce prosthesis that is within the standards of clinical acceptance of marginal discrepancy.

Materials and methods

Twenty metal copings each were fabricated by laser sintering and traditional casting method. The marginal gap at the buccal, lingual, mesial, and distal areas was measured using the silicone replica technique. The stereomicroscope and optical microscope were used to measure the marginal discrepancy between the working die and the copings. Statistical analysis was done using a t-test using Open-epi calculator software.

Results

The values indicate that the marginal gap was less for the copings fabricated using Co-Cr alloy crowns that were fabricated with direct metal laser-sintered technique than Co-Cr alloy crowns fabricated with conventional casting technique.

How to cite this article

Gautam N, Khajuria RR, Ahmed R, et al. A Comparative Evaluation of Marginal Accuracy of Co-Cr Metal Copings Fabricated Using Traditional Casting Techniques and Metal Laser Sintering. Int J Clin Pediatr Dent 2021;14(1):128-132.

The Concept of Sustainable Development of Modern Dentistry

This paper concerns the assessment of the current state of dentistry in the world and the prospects of its sustainable development. A traditional Chinese censer was adopted as the pattern, with a strong and stable support on three legs. The dominant diseases of the oral cavity are caries and periodontal diseases, with the inevitable consequence of toothlessness. From the caries 3.5–5 billion people suffer. Moreover, each of these diseases has a wide influence on the development of systemic complications. The territorial range of these diseases and their significant differentiation in severity in different countries and their impact on disability-adjusted life years index are presented (DALY). Edentulousness has a significant impact on the oral health-related quality of life (OHRQoL). The etiology of these diseases is presented, as well as the preventive and therapeutic strategies undertaken as a result of modifying the Deming circle through the fives’ rules idea. The state of development of Dentistry 4.0 is an element of the current stage of the industrial revolution Industry 4.0 and the great achievements of modern dental engineering. Dental treatment examples from the authors’ own clinical practice are given. The systemic safety of a huge number of dentists in the world is discussed, in place of the passive strategy of using more and more advanced personal protective equipment (PPE), introducing our own strategy for the active prevention of the spread of pathogenic microorganisms, including SARS-CoV-2. The ethical aspects of dentists’ activity towards their own patients and the ethical obligations of the dentist community towards society are discussed in detail. This paper is a polemic arguing against the view presented by a group of eminent specialists in the middle of last year in The Lancet. It is impossible to disagree with these views when it comes to waiting for egalitarianism in dental care, increasing the scope of prevention and eliminating discrimination in this area on the basis of scarcity and poverty. The views on the discrimination of dentistry in relation to other branches of medicine are far more debatable. Therefore, relevant world statistics for other branches of medicine are presented. The authors of this paper do not agree with the thesis that interventional dental treatment can be replaced with properly implemented prophylaxis. The final remarks, therefore, present a discussion of the prospects for the development of dentistry based on three pillars, analogous to the traditional Chinese censer obtaining a stable balance thanks to its three legs. The Dentistry Sustainable Development (DSD) > 2020 model, consisting of Global Dental Prevention (GDP), Advanced Interventionist Dentistry 4.0 (AID 4.0), and Dentistry Safety System (DSS), is presented.

Reliability of Metal 3D Printing with Respect to the Marginal Fit of Fixed Dental Prostheses: A Systematic Review and Meta-Analysis

Three-dimensional (3D) printing technologies have been widely used to manufacture crowns and frameworks for fixed dental prostheses. This systematic review and meta-analysis aimed to assess the reliability of the marginal fit of 3D-printed cobalt-chromium-based fixed dental prostheses in comparison to conventional casting methods. Articles published until 25 June 2020, reporting the marginal fit of fixed prostheses fabricated with metal 3D printing, were searched using electronic literature databases. After the screening and quality assessment, 21 eligible peer-reviewed articles were selected. Meta-analysis revealed that the marginal gap of the prostheses manufactured using 3D printing was significantly smaller compared to that manufactured using casting methods (standard mean difference (95% CI): -0.92 (-1.45, -0.38); Z = -3.37; p = 0.0008). The estimated difference between the single and multi-unit types did not differ significantly (p = 0.3573). In the subgroup analysis for the measurement methods, the tendency of marginal discrepancy between the 3D printing and casting groups was significantly different between articles that used direct observation and those that used the silicone replica technique (p < 0.001). Metal 3D printing technologies appear reliable as an alternative to casting methods in terms of the fit of the fixed dental prostheses. In order to analyze the factors influencing manufacturing and confirm the results of this review, further controlled laboratory and clinical studies are required.

Corrosion Resistance and Ion Release of Dental Prosthesis of CoCr Obtained by CAD-CAM Milling, Casting and Laser Sintering

Corrosion resistance and ion release behavior have been evaluated for thirty dental restoration samples obtained by three different manufacturing systems: computer-aided design and manufacturing (CAD-CAM), traditional casting and laser sintering. The alloy used was the CoCr alloy (same batch) generally used in clinical dentistry. Corrosion resistance has been evaluated by electrochemical testing in an artificial saliva medium at 37 °C. Corrosion parameters such as critical current density (icr), corrosion potential (Ecorr), and passive current density (ip), have been determined. Cobalt and Chromium ions released from the different samples have also been analyzed in an artificial saliva medium at 37 °C by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) at different immersion times. The casted samples showed higher corrosion rates and ion-release levels. The CAD-CAM milled samples presented lower ion-release levels and better corrosion resistance due to the total solubility of the chemical elements in only one phase with the same chemical composition. This homogeneity avoids the formation of electrochemical corrosion. Moreover, the absence of defects and residual stresses increases the corrosion resistance. Casted and laser sintered prostheses have shown the presence of Cr, W, and Nb rich-precipitates which are detrimental to the corrosion resistance. These precipitates produce a decrease in the Cr content on the surface. It is well known that the corrosion resistance increases with the Cr content by the formation of Chromium oxide on the surface that increases passivation. Consequently, the decrease in Cr induces an increase in corrosion and ion release.

Influence of the CAD-CAM Systems on the Marginal Accuracy and Mechanical Properties of Dental Restorations

The aim of this study was to compare the quality of different computer-assisted-design and computer assisted manufacturing systems (CAD-CAM) generated by only one scanner, focusing on vertical fit discrepancies and the mechanical properties. A master model was obtained from a real clinical situation: the replacement of an absent (pontic) tooth, with the construction of a fixed partial denture on natural abutments with three elements. Nine scans were performed by each tested and 36 copies were designed using a dental CAD-CAM software (Exocad). The frameworks were manufactured using three-axis and five-axis, with the same batch of the chrome-cobalt (CrCo) alloy. The frameworks were not cemented. A focus ion beam-high resolution scanning electron microscope (FIB-HRSEM) allowed us to obtain the vertical gap measurements in five points for each specimen. Roughness parameters were measured using white light interferometry (WLI). The samples were mechanically characterized by means of flexural tests. A servo-hydraulic testing machine was used with a cross-head rate of 1 mm/min. One-way ANOVA statistical analysis was performed to determine whether the vertical discrepancies and mechanical properties were significantly different between each group (significance level p < 0.05). The overall mean marginal gap values ranged: from 92.38 ± 19.24 µm to 19.46 ± 10.20 µm, for the samples produced by three-axis and five-axis machines, respectively. Roughness was lower in the five-axis machine than the three-axis one, and as a consequence, the surface quality was better when the five-axis machine was used. These results revealed a statistically significant difference (p < 0.005) in the mean marginal gap between the CAD-CAM systems studied. The flexural strength for these restorations range from 6500 to 7000 N, and does not present any statistical differences’ significance between two CAD-CAM systems studied. This contribution suggests that the number of axes improves vertical fit and surface quality due to the lower roughness. These claims show some discrepancies with other studies.

A systematic review on the accuracy of manufacturing techniques for cobalt chromium fixed dental prostheses

Purpose

To compare the fit and assess the accuracy of tooth-supported single and multi-unit FDPs in cobalt chromium fabricated using different manufacturing techniques.

Materials and methods

A systematic search was performed in three databases; PubMed, Scopus, and Web of Science, using clearly specified search terms and inclusion criteria. The search yielded 1071 articles and included 18 articles in the analysis. Data regarding the fit analyses and the methods of manufacturing were extracted and the accuracy was defined as the fit result minus the pre-set cement spacer. Internal gap (IntG) was the mean of all the internal measuring points and total gap (TotG) was the mean of all measuring points (marginal, cervical, chamfer, axial, occlusal).

Results

The total gap results for fit and accuracy irrespective of manufacturing technique were 96 μm and 54 μm for single crowns, 107 μm and 54 μm for multi-unit FDPs, and 98 μm and 54 μm for both single crowns and multi-unit FDPs combined. For total gap of single crowns soft milling had the highest accuracy, for multi-unit FDPs additive manufactured restorations had the highest accuracy. With the results grouped by impression technique, the accuracy for total gap was highest for digital impressions and lower for conventional impressions.

Conclusions

Due to the inherent limitations of this systematic review, it still remains unclear what effect the manufacturing technique has on the fit of FDPs. However, the descriptive results suggest that the marginal fit of cobalt chromium FDPs is not negatively affected by the manufacturing technique.

A Comparison Study of Marginal and Internal Fit Assessment Methods for Fixed Dental Prostheses

Numerous studies have previously evaluated the marginal and internal fit of fixed prostheses; however, few reports have performed an objective comparison of the various methods used for their assessment. The purpose of this study was to compare five marginal and internal fit assessment methods for fixed prostheses. A specially designed sample was used to measure the marginal and internal fit of the prosthesis according to the cross-sectional method (CSM), silicone replica technique (SRT), triple scan method (TSM), micro-computed tomography (MCT), and optical coherence tomography (OCT). The five methods showed significant differences in the four regions that were assessed (p < 0.001). The marginal, axial, angle, and occlusal regions showed low mean values: CSM (23.2 µm), TSM (56.3 µm), MCT (84.3 µm), and MCT (102.6 µm), respectively. The marginal fit for each method was in the range of 23.2-83.4 µm and internal fit (axial, angle, and occlusal) ranged from 44.8-95.9 µm, 84.3-128.6 µm, and 102.6-140.5 µm, respectively. The marginal and internal fit showed significant differences depending on the method. Even if the assessment values of the marginal and internal fit are found to be in the allowable clinical range, the differences in the values according to the method should be considered.

Marginal fit of metal-ceramic crowns fabricated by using a casting and two selective laser melting processes before and after ceramic firing

STATEMENT OF PROBLEM

Few studies have investigated changes in the marginal fit of metal-ceramic restorations fabricated by selective laser melting (SLM) techniques after the application of veneering ceramic.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal fit (silicone replica technique) and internal porosity (cross-section analysis) of cobalt-chromium (Co-Cr) alloy metal crowns prepared by using 2 SLM processes together with a casting technique before and after ceramic veneering.

MATERIAL AND METHODS

Cast single Co-Cr crowns and SLM-processed crowns with large (SLML) or small (SLMS) porosity were prepared (n=20/group), and half were subjected to ceramic veneering. On a single Co-Cr master die, the marginal discrepancy (MD) and absolute marginal discrepancy (AMD) of the crowns were measured by using the silicone replica technique, in which each replica was cut into 4 sections before and after ceramic veneering (n=10 for each subgroup). After marginal fit measurements, each metal coping was cross-sectioned into 4 parts, and 5 rectangular optical microscope images were acquired on both outer corners of each quarter. The porosity was then calculated as the ratio of the black-to-white pixels on the binarized images. The data were analyzed by 2-way ANOVA and the post hoc test (Tukey or Student t test) (α=.05).

RESULTS

Before ceramic veneering, the 2 SLM groups showed significantly larger MDs than the casting group (56.4 ±10.4 μm) (P<.05). A significant increase in MD after ceramic veneering was detected only in the SLML group (P<.001). The AMD values showed a similar trend with MD values. The 2 SLM groups (in particular, SLML) showed a significantly higher amount of porosity than the casting group before ceramic veneering (P<.001). Only the SLML group showed a significant decrease in the amount of porosity after ceramic veneering (P<.001).

CONCLUSIONS

Within the limitations of this in vitro study, large internal porosity within the SLM-fabricated Co-Cr metal copings affected the marginal fit of the metal-ceramic crowns. However, all the MD values of the 3 groups were lower than the acceptable range even after the application of veneering ceramic.

Reproducibility of different coping arrangements fabricated by dental micro-stereolithography: Evaluation of marginal and internal gaps in metal copings

Background/purpose

To evaluate the reproducibility of the marginal and internal gaps of metal copings fabricated using dental micro-stereolithography (μ-SLA), which is an additive manufacturing system.

Materials and methods

A study cast of abutment tooth 46 was made from type-IV dental stone and was scanned to create a standard triangulation language file. Arrays of one (ORM), three (TRM), and six (SRM) resin copings were then fabricated on the μ-SLA build platform using investment, burnout, and casting (n = 12). The marginal and internal gaps of these metal copings were measured using a silicone-replica technique with a digital microscope (×160). The data obtained were analyzed using a non-parametric Kruskal–Wallis H test, a post-hoc Mann–Whitney U test, and a Bonferroni correction.

Results

The mean and standard deviation of the marginal gap for each group were measured and found to be 81.1 and 53.2 μm, 68.3 and 44.8 μm, and 90.3 and 57.7 μm for ORM, TRM, and SRM, respectively. There were no statistical differences in the marginal gaps of the three groups (p > 0.05).

Conclusion

The marginal and internal gap of ORM, TRM and SRM groups were considered clinically acceptable.

Evaluation of the Marginal and Internal Fit of Implant-Supported Metal Copings Fabricated with 3 Different Techniques: An In Vitro Study

PURPOSE

To compare the marginal and internal fit of cobalt-chromium (Co-Cr) alloy copings fabricated by with lost wax technique (LW), computer-aided design and computer-aided manufacturing (CAD/CAM), and direct metal laser sintering (DMLS).

MATERIALS AND METHODS

Thirty-six tissue level, straight titanium abutments were screwed onto implant replicas. All specimens were embedded in acrylic resin and randomly divided into 3 subgroups according to the fabrication of metal coping: LW, CAD/CAM, and DMLS. In total, 36 (n = 12/group) Co-Cr implant-supported metal copings were prepared. Marginal, intermarginal, axial, and occlusal fits of each coping were measured using the silicone replica technique. The data were evaluated statistically using one-way ANOVA and Bonferioni post-hoc test (α = 0.05).

RESULTS

The CAD/CAM group showed significantly lower marginal fit than the LW group and DMLS groups (p < 0.001). The marginal fit of the LW group was not significantly different from the DMLS group (p = 0.721). No significant difference found among the fabrication methods in terms of intermarginal fit (p = 0.913). The CAD/CAM group showed lower axial fit than the LW group (p = 0.026), but there was no statistical difference between the DMLS group and the LW (p = 0.999) and CAD/CAM groups (p = 0.247). No significant differences found among the fabrication methods in terms of occlusal fit (p = 0.158).

CONCLUSIONS

The LW and DMLS groups showed better marginal fit compared to the CAD/CAM group; however, the CAD/CAM group was better than the LW group in terms of axial fit. All fabrication methods demonstrated similar intermarginal and occlusal fit.

A study on the machining accuracy of dental digital method focusing on dental inlay

PURPOSE

The purpose of this study was to compare the cutting method and the lamination method to investigate whether the CAD data of the proposed inlay shape are machined correctly.

MATERIALS AND METHODS

The Mesial-Occlusal shape of the inlay was modeled by changing the stereolithography (STL). Each group used SLS (metal powder) or SLA (photocurable resin) in the additive method, and wax or zirconia in the subtractive method (n=10 per group, total n=40). Three-dimensional (3D) analysis program (Geomagic Control X inspection software; 3D systems) was used for the alignment and analysis. The root mean square (RMS) in the 2D plane state was measured within 50 µm radius of eight comparison measuring points (CMP). Differences were analyzed using one-way analysis of variance and post-hoc Tukey's test were used (α=.05).

RESULTS

There was a significant difference in RMS only in SLA and SLS of 2D section (P<.05). In CMP mean, CMP 4 (−5.3±46.7 µm) had a value closest to 0, while CMP 6 (20.1±42.4 µm) and CMP 1 (−89.2±61.4 µm) had the greatest positive value and the greatest negative value, respectively.

CONCLUSION

Since the errors obtained from the study do not exceed the clinically acceptable values, the lamination method and the cutting method can be used clinically.

Additive manufacturing of biomaterials

Biomaterials are used to engineer functional restoration of different tissues to improve human health and the quality of life. Biomaterials can be natural or synthetic. Additive manufacturing (AM) is a novel materials processing approach to create parts or prototypes layer-by-layer directly from a computer aided design (CAD) file. The combination of additive manufacturing and biomaterials is very promising, especially towards patient specific clinical applications. Challenges of AM technology along with related materials issues need to be realized to make this approach feasible for broader clinical needs. This approach is already making a significant gain towards numerous commercial biomedical devices. In this review, key additive manufacturing methods are first introduced followed by AM of different materials, and finally applications of AM in various treatment options. Realization of critical challenges and technical issues for different AM methods and biomaterial selections based on clinical needs are vital. Multidisciplinary research will be necessary to face those challenges and fully realize the potential of AM in the coming days.

Fitness and retentive force of cobalt-chromium alloy clasps fabricated with repeated laser sintering and milling

PURPOSE

With computer-aided design and computer-aided manufacturing (CAD/CAM), the study was conducted to create a removable partial denture (RPD) framework using repeated laser sintering rather than milling and casting techniques. This study experimentally evaluated the CAM clasp and compared it to a conventional cast clasp.

METHODS

After the tooth die was scanned, an Akers clasp was designed using CAD with and without 50μm of digital relief on the occlusal surface of the tooth die. Cobalt-chromium (Co-Cr) alloy clasps were fabricated using repeated laser sintering (RLS) and milling as one process simultaneously (hybrid manufacturing; HM). The surface roughness of the rest region, gap distances between clasp and tooth die, initial retentive forces, and changes of retentive forces up to 10,000 insertion/removal cycles were measured before and after heat treatment. The HM clasp was compared to the cast clasp and the clasp made by repeated laser sintering only without a milling process.

RESULTS

The HM clasp surface was smoother than those of cast and RLS clasps. With the digital relief, the fitness accuracy of the HM clasp improved. The retentive forces of the HM clasps with relief and after heat treatment were significantly greater than for the cast clasp. HM clasps demonstrated a constant or slight decrease of retention up to 10,000 cycles.

CONCLUSIONS

HM clasp exhibited better fitness accuracy and retentive forces. The possibility of clinically using HM clasps as well as conventional cast clasps can be suggested.

Engineering 3D Hydrogels for Personalized In Vitro Human Tissue Models

There is a growing interest in engineering hydrogels for 3D tissue and disease models. The major motivation is to better mimic the physiological microenvironment of the disease and human condition. 3D tissue models derived from patients' own cells can potentially revolutionize the way treatment and diagnostic alternatives are developed. This requires development of tissue mimetic hydrogels with user defined and tunable properties. In this review article, a recent summary of 3D hydrogel platforms for in vitro tissue and disease modeling is given. Hydrogel design considerations and available hydrogel systems are summarized, followed by the types of currently available hydrogel models, such as bulk hydrogels, porous scaffolds, fibrous scaffolds, hydrogel microspheres, hydrogel sandwich systems, microwells, and 3D bioprinted constructs. Although hydrogels are utilized for a wide range of tissue models, this article focuses on liver and cancer models. This article also provides a detailed section on current challenges and future perspectives of hydrogel-based tissue models.

Evaluation of marginal and internal gaps in single and three-unit metal frameworks made by micro-stereolithography

PURPOSE

The purpose of this study is to compare single and three-unit metal frameworks that are produced by micro-stereolithography.

MATERIALS AND METHODS

Silicone impressions of a selected molar and a premolar were used to make master abutments that were scanned into a stereolithography file. The file was processed with computer aided design software to create single and three-unit designs from which resin frameworks were created using micro-stereolithography. These resin frameworks were subjected to investment, burnout, and casting to fabricate single and three-unit metal ones that were measured under a digital microscope by using the silicone replica technique. The measurements were verified by means of the Mann-Whitney U test (α=.05).

RESULTS

The marginal gap was 101.9 ± 53.4 µm for SM group and 104.3 ± 62.9 µm for TUM group. The measurement of non-pontics in a single metal framework was 93.6 ± 43.9 µm, and that of non-pontics in a three-unit metal framework was 64.9 ± 46.5 µm. The dimension of pontics in a single metal framework was 110.2 ± 61.4 µm, and that of pontics in a three-unit metal framework was 143.7 ± 51.8 µm.

CONCLUSION

The marginal gap was smaller for the single metal framework than for the three-unit one, which requires further improvement before it can be used for clinical purposes.

Comparison and evaluation of marginal and internal gaps in cobalt-chromium alloy copings fabricated using subtractive and additive manufacturing

PURPOSE

To evaluate the marginal and internal gaps of cobalt-chromium (Co-Cr) alloy copings fabricated using subtractive and additive manufacturing.

METHODS

A study model of an abutment tooth 46 was prepared by a 2-step silicone impression with dental stone. Fifteen stereolithography files for Co-Cr alloy copings were compiled using a model scanner and dental CAD software. Using the lost wax (LW), wax block (WB), soft metal block (SMB), microstereolithography (μ-SLA), and selected laser melting (SLM) techniques, 15 Co-Cr alloy copings were fabricated per group. The marginal and internal gaps of these Co-Cr alloy copings were measured using a digital microscope (160×), and the data obtained were analyzed using the non-parametric Kruskal-Wallis H-test and post-hoc Mann-Whitney U-test with Bonferroni correction.

RESULTS

The mean values of the marginal, axial wall, and occlusal gaps were 91.8, 83.4, and 163μm in the LW group; 94.2, 77.5, and 122μm in the WB group; 60.0, 79.4, and 90.8μm in the SMB group; 154, 72.4, and 258μm in the μ-SLA group; and 239, 73.6, and 384μm in the SLM group, respectively. The differences in the marginal and occlusal gaps between the 5 groups were statistically significant (P<.05).

CONCLUSIONS

The marginal gaps of the LW, WB, and SMB groups were within the clinically acceptable limit, but further improvements in the μ-SLA and SLM approaches may be required prior to clinical implementation.

Evaluation of marginal and internal gaps of Ni-Cr and Co-Cr alloy copings manufactured by microstereolithography

PURPOSE

The purpose of this study was to evaluate the marginal and internal gaps of Ni-Cr and Co-Cr copings, fabricated using the dental µ-SLA system.

MATERIALS AND METHODS

Ten study dies were made using a two-step silicone impression with a dental stone (type IV) from the master die of a tooth. Ni-Cr (NC group) and Co-Cr (CC group) alloy copings were designed using a dental scanner, CAD software, resin coping, and casting process. In addition, 10 Ni-Cr alloy copings were manufactured using the lost-wax technique (LW group). The marginal and internal gaps in the 3 groups were measured using a digital microscope (160 ×) with the silicone replica technique, and the obtained data were analyzed using the non-parametric Kruskal-Wallis H test. Post-hoc comparisons were performed using Bonferroni-corrected Mann-Whitney U tests (α=.05).

RESULTS

The mean (±standard deviation) values of the marginal, chamfer, axial wall, and occlusal gaps in the 3 groups were as follows: 81.5±73.8, 98.1±76.1, 87.1±44.8, and 146.8±78.7 µm in the LW group; 76.8±48.0, 141.7±57.1, 80.7±47.5, and 194.69±63.8 µm in the NC group; and 124.2±52.0, 199.5±71.0, 67.1±37.6, and 244.5±58.9 µm in the CC group.

CONCLUSION

The marginal gap in the LW and NC groups were clinically acceptable. Further improvement is needed for CC group to be used clinical practice.

Comparative Evaluation of Effects of Laser Modalities on Shear Bond Strengths of Veneering Porcelains to Laser Sintered Substructures: An In Vitro Study

OBJECTIVE

Laser modalities and direct metal laser sintering (DMLS) have a potential to enhance micromechanical bonding between dental super- and infrastructures. However, the effect of different manufacturing methods on the metal-ceramic bond strength needs further evaluation. We investigated the effect of surface treatment with Er:YAG, Nd:YAG, and Ho:YAG lasers on the shear bond strength (SBS) of high-fusion dental porcelains (Vita and G-Ceram) to infrastructures prepared with DMLS in vitro settings.

MATERIALS AND METHODS

Study specimens (n = 128) were randomly divided into study subsets (n = 8), considering treatment types applied on the surface of infrastructures, including sandblasting and selected laser modalities; infrastructure types as direct laser sintered (DLS) and Ni-Cr based; and superstructure porcelains as Vita and G-Ceram. The SBS test was performed to assess the effectiveness of surface modifications that were also examined with a stereo microscope.

RESULTS

Considering laser procedure types, the highest SBS values were obtained by Er:YAG laser, followed by, with a decreasing efficiency, Ho:YAG laser and sandblasting procedures, and Nd:YAG laser procedure (p < 0.05). Nd:YAG laser decreases the bonding of Vita and G-Ceram in all the infrastructures compared with sandblasting. Considering porcelains, the highest SBS values were obtained by Vita (p < 0.05). Considering infrastructures, the highest SBS values were obtained by DMLS procedure (p < 0.05). The laser procedures caused surface irregularities as revealed by the stereo microscopic examination.

CONCLUSIONS

In current experimental settings, Er:YAG laser applied to DLS infrastructure veneered with Vita porcelain increases bonding strength more distinctly, and Nd:YAG laser applied to Ni-Cr-based infrastructure veneered with G-Ceram porcelain alters bonding strength unfavorably.

Current and emerging applications of 3D printing in medicine

Three-dimensional (3D) printing enables the production of anatomically matched and patient-specific devices and constructs with high tunability and complexity. It also allows on-demand fabrication with high productivity in a cost-effective manner. As a result, 3D printing has become a leading manufacturing technique in healthcare and medicine for a wide range of applications including dentistry, tissue engineering and regenerative medicine, engineered tissue models, medical devices, anatomical models and drug formulation. Today, 3D printing is widely adopted by the healthcare industry and academia. It provides commercially available medical products and a platform for emerging research areas including tissue and organ printing. In this review, our goal is to discuss the current and emerging applications of 3D printing in medicine. A brief summary on additive manufacturing technologies and available printable materials is also given. The technological and regulatory barriers that are slowing down the full implementation of 3D printing in the medical field are also discussed.

Effect of repeated ceramic firings on the marginal and internal adaptation of metal-ceramic restorations fabricated with different CAD-CAM technologies

STATEMENT OF PROBLEM

The use of computer-aided design and computer-aided manufacturing (CAD-CAM) for metal-ceramic restorations has increased with advances in the technology. However, little is known about the marginal and internal adaptation of restorations fabricated using laser sintering (LS) and soft milling (SM). Moreover, the effects of repeated ceramic firings on the marginal and internal adaptation of metal-ceramic restorations fabricated with LS and SM is also unknown.

PURPOSE

The purpose of this in vitro study was to investigate the effects of repeated ceramic firings on the marginal and internal adaptation of metal-ceramic copings fabricated using the lost wax (LW), LS, and SM techniques.

MATERIAL AND METHODS

Ten LW, 10 LS, and 10 SM cobalt-chromium (Co-Cr) copings were fabricated for an artificial tooth (Frasaco GmbH). After the application of veneering ceramic (VITA VMK Master; VITA Zahnfabrik), the marginal and internal discrepancies of these copings were measured with a silicone indicator paste and a stereomicroscope at ×100 magnification after the first, second, and third clinical simulated ceramic firing cycles. Repeated measures 2-way ANOVA and the Fisher LSD post hoc test were used to evaluate differences in marginal and internal discrepancies (α=.05).

RESULTS

Neither fabrication protocol nor repeated ceramic firings had any statistically significant effect on internal discrepancy values (P>.05). Marginal discrepancy values were also statistically unaffected by repeated ceramic firings (P>.05); however, the fabrication protocol had a significant effect on marginal discrepancy values (P<.001), with LW resulting in higher marginal discrepancy values than LS or SM (P<.05). Marginal discrepancy values did not vary between LS and SM (P>.05).

CONCLUSIONS

All groups demonstrated clinically acceptable marginal adaptation after repeated ceramic firing cycles; however, the LS and SM groups demonstrated better marginal adaptation than that of LW group and may be appropriate clinical alternatives to LW.

An Evaluation of the Gap Sizes of 3-Unit Fixed Dental Prostheses Milled from Sintering Metal Blocks

This study assessed the clinical acceptability of sintering metal-fabricated 3-unit fixed dental prostheses (FDPs) based on gap sizes. Ten specimens were prepared on research models by milling sintering metal blocks or by the lost-wax technique (LWC group). Gap sizes were assessed at 12 points per abutment (premolar and molar), 24 points per specimen (480 points in a total in 20 specimens). The measured points were categorized as marginal, axial wall, and occlusal for assessment in a silicone replica. The silicone replica was cut through the mesiodistal and buccolingual center. The four sections were magnified at 160x, and the thickness of the light body silicone was measured to determine the gap size, and gap size means were compared. For the premolar part, the mean (standard deviation) gap size was nonsignificantly (p = 0.139) smaller in the SMB group (68.6 ± 35.6 μm) than in the LWC group (69.6 ± 16.9 μm). The mean molar gap was nonsignificantly smaller (p = 0.852) in the LWC (73.9 ± 25.6 μm) than in the SMB (78.1 ± 37.4 μm) group. The gap sizes were similar between the two groups. Because the gap sizes were within the previously proposed clinically accepted limit, FDPs prepared by sintered metal block milling are clinically acceptable.

Marginal Accuracy and Internal Fit of 3-D Printing Laser-Sintered Co-Cr Alloy Copings

Laser sintered technology has been introduced for clinical use and can be utilized more widely, accompanied by the digitalization of dentistry and the development of direct oral scanning devices. This study was performed with the aim of comparing the marginal accuracy and internal fit of Co-Cr alloy copings fabricated by casting, CAD/CAM (Computer-aided design/Computer-assisted manufacture) milled, and 3-D laser sintered techniques. A total of 36 Co-Cr alloy crown-copings were fabricated from an implant abutment. The marginal and internal fit were evaluated by measuring the weight of the silicone material, the vertical marginal discrepancy using a microscope, and the internal gap in the sectioned specimens. The data were statistically analyzed by One-way ANOVA (analysis of variance), a Scheffe’s test, and Pearson’s correlation at the significance level of p = 0.05, using statistics software. The silicone weight was significantly low in the casting group. The 3-D laser sintered group showed the highest vertical discrepancy, and marginal-, occlusal-, and average- internal gaps (p < 0.05). The CAD/CAM milled group revealed a significantly high axial internal gap. There are moderate correlations between the vertical marginal discrepancy and the internal gap variables (r = 0.654), except for the silicone weight. In this study, the 3-D laser sintered group achieved clinically acceptable marginal accuracy and internal fit.

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.

Clasp fabrication using one-process molding by repeated laser sintering and high-speed milling

PURPOSE

A single machine platform that integrates repeated laser sintering and high-speed milling for one-process molding has been developed.

METHODS

The Akers clasp was designed using the CAD system (DWOS Partial Frameworks, Dental Wings) and fabricated using repeated laser sintering and a high-speed milling machine (LUMEX Advance-25, Matsuura) with 50-μm Co-Cr particles (CAM clasp). As controls, cast clasps of the same forms were also prepared using conventional casting methods with a Co-Cr alloy and CP titanium Grade 3. After the surface roughness was measured, the gap distance between the clasps and the tooth die was assessed using the silicone film method. The initial retentive force and changes in retention up to 10,000 cycles were also measured. The data were analyzed using two-way ANOVA and Tukey's multiple comparison test (α=0.05).

RESULTS

CAM clasps exhibited significantly smoother surfaces than those of cast Co-Cr and CP Ti clasps (p<0.05). However, the gap distances of the CAM clasps were significantly greater than those of the cast clasps (p<0.05). The retentive forces of both CAM and cast Co-Cr clasps were significantly higher than those of CP Ti clasps. (p<0.05). The retention of CAM clasps demonstrated a constant or slight decrease from 1000 up to 10,000 cycles.

CONCLUSIONS

The CAM clasp made by repeated laser sintering and high-speed milling can be used effectively as an RPD component.

A microcomputed tomography evaluation of the marginal fit of cobalt-chromium alloy copings fabricated by new manufacturing techniques and alloy systems

STATEMENT OF PROBLEM

Although new digital manufacturing techniques are attracting interest in dentistry, few studies have comprehensively investigated the marginal fit of fixed dental prostheses fabricated with such techniques.

PURPOSE

The purpose of this in vitro microcomputed tomography (μCT) study was to evaluate the marginal fit of cobalt-chromium (Co-Cr) alloy copings fabricated by casting and 3 different computer-aided design and computer-aided manufacturing (CAD-CAM)-based processing techniques and alloy systems.

MATERIAL AND METHODS

Single Co-Cr metal crowns were fabricated using 4 different manufacturing techniques: casting (control), milling, selective laser melting, and milling/sintering. Two different commercial alloy systems were used for each fabrication technique (a total of 8 groups; n=10 for each group). The marginal discrepancy and absolute marginal discrepancy of the crowns were determined with μCT. For each specimen, the values were determined from 4 different regions (sagittal buccal, sagittal lingual, coronal mesial, and coronal distal) by using imaging software and recorded as the average of the 4 readings. For each parameter, the results were statistically compared with 2-way analysis of variance and appropriate post hoc analysis (using Tukey or Student t test) (α=.05).

RESULTS

The milling and selective laser melting groups showed significantly larger marginal discrepancies than the control groups (70.4 ±12.0 and 65.3 ±10.1 μm, respectively; P<.001), whereas the milling/sintering groups exhibited significantly smaller values than the controls (P=.004). The milling groups showed significantly larger absolute marginal discrepancy than the control groups (137.4 ±29.0 and 139.2 ±18.9 μm, respectively; P<.05). In the selective laser melting and milling/sintering groups, the absolute marginal discrepancy values were material-specific (P<.05). Nonetheless, the milling/sintering groups yielded statistically comparable (P=.935) or smaller (P<.001) absolute marginal discrepancies to the control groups.

CONCLUSIONS

The findings of this in vitro μCT study showed that the marginal fit values of the Co-Cr alloy greatly depended on the fabrication methods and, occasionally, the alloy systems. Fixed dental prostheses produced by using the milling/sintering technique can be considered clinically acceptable in terms of marginal fit.