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Clinical reliability of self-adhesive luting resins compared to other adhesive procedures: A systematic review and meta-analysis. J Dent 2023; 129:104394. [PMID: 36566829 DOI: 10.1016/j.jdent.2022.104394] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This systematic review aimed to collect and interpret the randomized clinical trials (RCTs) that investigated the outcome of the self-adhesive luting resins (SA) compared to total-etch (TE), selective etch with dentin adhesives (Sle), selective etch without dentin adhesives (SleSA) or self-etch adhesives (SE). DATA SOURCES A thorough search of Internet databases was conducted without language restrictions, and the search ran up to and including April 2022. The illegible records citations were checked for more relevant clinical studies. STUDY SELECTION/RESULTS The inclusion criteria were randomized controlled trials (RCTs) that compared self-adhesive luting resins with total-etch, selective-etch, or self-etch adhesives regarding postoperative sensitivity, incidences of debonding, and survival rates of indirect restorations. From 1732 records, 9 RCTs met the eligibility criteria. Three RCTs compared total-etch adhesive to self-adhesive luting resin for intracoronal restorations, one RCT compared selective etch to self-adhesive luting resin for inlays, and 5 RCTs compared self-adhesive to other protocols for partial ceramic crowns. Postoperative sensitivity showed a non-statistically significant difference between SA and other adhesive protocols, SA revealed a non-statistically significant difference in debonding and survival to TE, but a lower statistically significant difference to Sle, SleSA, and SE. CONCLUSIONS Postoperative sensitivity might not be affected by the adhesive protocol. In relatively short observation, TE revealed comparable survival to SA for intracoronal restorations. SE and Sle exhibited the best clinical outcomes, followed by SleSA. Selective etch, and self-etch adhesives are preferable to self-adhesive resins. CLINICAL SIGNIFICANCE The significance of enamel etching and the superiority of self-etching adhesives over self-adhesive luting resins for reliable and durable bonding and improved clinical outcomes. However, long-term RCTs, particularly for total-etch comparison to self-adhesive luting resins, might be recommended to derive further evidence.
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Newaskar PS, Sonkesriya S, Singh R, Palekar U, Bagde H, Dhopte A. Evaluation and Comparison of Five-Year Survival of Tooth-Supported Porcelain Fused to Metal and All-Ceramic Multiple Unit Fixed Prostheses: A Systematic Review. Cureus 2022; 14:e30338. [PMID: 36407172 PMCID: PMC9663878 DOI: 10.7759/cureus.30338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023] Open
Abstract
The prosthesis must have good survival despite being functional for at least 5-10 years. This makes sure that the replacement of missing teeth does not become a repeated expense. Of 579 identified articles, 15 met the inclusion criteria for systematic review. Missing teeth replacement materials are divided into two groups: porcelain fused to metal and all ceramics. Data related to survival rates as well as the most common mode of failure is observed from both groups. It was observed that porcelain fused to metal prostheses had an approximately 99.5% survival rate and an approximately 92% survival rate for all-ceramic tooth-supported prostheses after five years of insertion. Porcelain-fused-to-metal (PFM) prostheses had a better survival rate after five years of insertion as compared to all-ceramic prostheses. Porcelain fused to metal should be the treatment of choice for dentists and patients when missing teeth need to be fixed.
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Affiliation(s)
- Prabha Shakya Newaskar
- Department of Prosthodontics, Rural Dental College, Pravara Institute of Medical Sciences - Deemed University (PIMS-DU), Loni, IND
| | - Subhash Sonkesriya
- Department of Prosthodontics, Government Dental College and Hospital, Indore, IND
| | - Rashmi Singh
- Department of Prosthodontics, Mansarovar Dental College, Hospital and Research Centre, Bhopal, IND
| | - Umesh Palekar
- Department of Prosthodontics, Rural Dental College, Pravara Institute of Medical Sciences - Deemed University (PIMS-DU), Loni, IND
| | - Hiroj Bagde
- Periodontology, Rama Dental College and Research Centre, Kanpur, IND
| | - Ashwini Dhopte
- Oral Medicine and Radiology, Rama Dental College and Research Centre, Kanpur, IND
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Do tooth-supported zirconia restorations present more technical failures related to fracture or loss of retention? Systematic review and meta-analysis. Clin Oral Investig 2022; 26:5129-5142. [PMID: 35660957 DOI: 10.1007/s00784-022-04573-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/29/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This systematic review was performed to determine the main cause of technical failure of tooth-supported zirconia crowns and fixed partial dentures (FPDs), categorizing them as fracture/chipping or loss of retention/decementation. MATERIALS AND METHODS Electronic and manual searches were performed for randomized clinical trials, prospective clinical trials, and prospective cohort studies that reported the technical failure rates of zirconia restorations. The Cochrane Collaboration risk-of-bias tool and Newcastle-Ottawa scale were used to assess the quality of the studies. RESULTS Fifty-two studies were included and most of them had unclear risk of bias. Considering all reported fractures/chipping, for veneered crowns with 1 to 3 years of follow-up, the relative risk (RR) of fracture in relation to loss or retention was 3.95 (95% CI 1.18-13.23; p = 0.03). For 4 to 6 years of follow-up, the RR was 5.44 (95% CI 1.41-20.92; p = 0.01). For veneered FPDs with 1 to 3 years of follow-up, the RR was 5.98 (95% CI 2.31-15.01; p = 0.0002). For 4 to 6 years of follow-up, the RR was 3.70 (95% CI 1.63-8.41; p = 0.002). For 7 years or more of follow-up, the RR was 3.45 (95% CI 1.84-6.46; p = 0.0001). When only framework fractures were considered, there were no significant differences for the RR in all follow-up periods (p > 0.05). CONCLUSIONS Higher RR for fracture/chipping in relation to decementation for veneered zirconia crowns and FPDs at all follow-up times. For framework fractures, no difference was observed between the risk of failure of the restoration due to fracture or decementation. CLINICAL RELEVANCE Zirconia crowns and FPDs showed relatively high success and survival rates. However, considering the technical failures, there is approximately four times higher chance of fracture/chipping than loss of retention for both single and multi-unit tooth-supported veneered zirconia restorations.
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Fardin VP, Bonfante G, Coelho PG, Bergamo ETP, Bordin D, Janal MN, Tovar N, Witek L, Bonfante EA. Residual stress estimated by nanoindentation in pontics and abutments of veneered zirconia fixed dental prostheses. J Appl Oral Sci 2022; 30:e20210475. [PMID: 35476114 PMCID: PMC9041093 DOI: 10.1590/1678-7757-2021-0475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/10/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022] Open
Abstract
Glass ceramics' fractures in zirconia fixed dental prosthesis (FDP) remains a clinical challenge since it has higher fracture rates than the gold standard, metal ceramic FDP. Nanoindentation has been shown a reliable tool to determine residual stress of ceramic systems, which can ultimately correlate to failure-proneness. OBJECTIVES To assess residual tensile stress using nanoindentation in veneered three-unit zirconia FDPs at different surfaces of pontics and abutments. METHODOLOGY Three composite resin replicas of the maxillary first premolar and crown-prepared abutment first molar were made to obtain three-unit FDPs. The FDPs were veneered with glass ceramic containing fluorapatite crystals and resin cemented on the replicas, embedded in epoxy resin, sectioned, and polished. Each specimen was subjected to nanoindentation in the following regions of interest: 1) Mesial premolar abutment (MPMa); 2) Distal premolar abutment (DPMa); 3) Buccal premolar abutment (BPMa); 4) Lingual premolar abutment (LPMa); 5) Mesial premolar pontic (MPMp); 6) Distal premolar pontic (DPMp); 7) Buccal premolar pontic (BPMp); 8) Lingual premolar pontic (LPMp); 9) Mesial molar abutment (MMa); 10) Distal molar abutment (DMa); 11) Buccal molar abutment (BMa); and 12) Lingual molar abutment (LMa). Data were assessed using Linear Mixed Model and Least Significant Difference (95%) tests. RESULTS Pontics had significantly higher hardness values than premolar (p=0.001) and molar (p=0.007) abutments, suggesting lower residual stress levels. Marginal ridges yielded higher hardness values for connectors (DPMa, MMa, MPMp and DPMp) than for outer proximal surfaces of abutments (MPMa and DMa). The mesial marginal ridge of the premolar abutment (MPMa) had the lowest hardness values, suggesting higher residual stress concentration. CONCLUSIONS Residual stress in three-unit FDPs was lower in pontics than in abutments. The outer proximal surfaces of the abutments had the highest residual stress concentration.
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Affiliation(s)
- Vinicius Pavesi Fardin
- Universidade de São PauloFaculdade de Odontologia de BauruDepartamento de Prótese e PeriodontiaBauruSão PauloBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Prótese e Periodontia, Bauru, São Paulo, Brasil.
| | - Gerson Bonfante
- Universidade de São PauloFaculdade de Odontologia de BauruDepartamento de Prótese e PeriodontiaBauruSão PauloBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Prótese e Periodontia, Bauru, São Paulo, Brasil.
| | - Paulo G. Coelho
- New York University College of DentistryDepartment of BiomaterialsNew YorkUnited StatesNew York University College of Dentistry, Department of Biomaterials, New York, United States.
- New York University TandonSchool of EngineeringDepartment of Mechanical and Aerospace EngineeringBrooklynNew YorkUnited StatesNew York University Tandon, School of Engineering, Department of Mechanical and Aerospace Engineering, Brooklyn, New York, United States.
- New York University Grossman School of MedicineHansjörg Wyss Department of Plastic SurgeryNew YorkUnited StatesNew York University Grossman School of Medicine, Hansjörg Wyss Department of Plastic Surgery, New York, United States.
| | - Edmara T. P. Bergamo
- Universidade de São PauloFaculdade de Odontologia de BauruDepartamento de Prótese e PeriodontiaBauruSão PauloBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Prótese e Periodontia, Bauru, São Paulo, Brasil.
| | - Dimorvan Bordin
- Universidade de GuarulhosGuarulhosSão PauloBrasilUniversidade de Guarulhos (UNG) – UNIVERITAS, Guarulhos, São Paulo, Brasil.
| | - Malvin N. Janal
- New York University College of DentistryDepartment of Epidemiology and Health PromotionNew YorkUnited StatesNew York University College of Dentistry, Department of Epidemiology and Health Promotion, New York, United States.
| | - Nick Tovar
- New York University College of DentistryDepartment of BiomaterialsNew YorkUnited StatesNew York University College of Dentistry, Department of Biomaterials, New York, United States.
| | - Lukasz Witek
- New York University College of DentistryDepartment of BiomaterialsNew YorkUnited StatesNew York University College of Dentistry, Department of Biomaterials, New York, United States.
- New York UniversityNYU Tandon School of EngineeringDepartment of Biomedical EngineeringBrooklynNYUnited StatesNew York University, NYU Tandon School of Engineering, Department of Biomedical Engineering, Brooklyn, NY, United States.
| | - Estevam A. Bonfante
- Universidade de São PauloFaculdade de Odontologia de BauruDepartamento de Prótese e PeriodontiaBauruSão PauloBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Prótese e Periodontia, Bauru, São Paulo, Brasil.
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Comparative Assessment of the Functional Parameters for Metal-Ceramic and All-Ceramic Teeth Restorations in Prosthetic Dentistry-A Literature Review. BIOLOGY 2022; 11:biology11040556. [PMID: 35453755 PMCID: PMC9024664 DOI: 10.3390/biology11040556] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 12/16/2022]
Abstract
Simple Summary In the last decades, the science and technology of all-ceramic teeth restorations witnessed the fastest-growing field of restorative materials in research and development for fixed prosthodontics. Due to their properties, characterized by a high level of biocompatibility, excellent optical properties, and high fracture resistance, all-ceramic material can also be used in the posterior areas of the dental arches. However, metal-ceramic fixed partial dentures are still perceived as the golden standard for those restorations, thanks to the positive clinical outcomes. Irrespective of the materials of which fixed partial dentures are performed, their success rates depend on the expected outcome and on how they perform in the oral environment. Such conditions of failure restorations may include biological factors (i.e., secondary decay, loss of vitality, periodontal disease, or abutment fracture) or technical factors (i.e., chipping, ceramic fracture, framework fracture, or loss of retention). Our aim is to provide the current evidence for the efficacy of metal-ceramics and all-ceramics in the treatment of multiple posterior edentulous spaces. Moreover, we aim to compare the survival rates of metal-ceramic and all-ceramic fixed partial dentures in terms of functionality and biocompatibility in all the aforementioned clinical situations. Our results have shown that all all-ceramic systems, especially densely sintered zirconia and reinforced glass ceramics, have a promising future to satisfy both practitioners and patients. However, technical and biological complications need to be taken into account when planning multi-unit fixed partial dentures for the posterior areas. Abstract The metal-ceramic fixed partial prosthesis is the golden standard for posterior tooth restorations. Following the demands of patients and clinicians for metal-free restorations, all-ceramic materials were developed as they offer an adequate alternative with better optical qualities and good mechanical properties. This study aims to carry out a bibliographic review to assess the survival rate and the biological and technical complications of all-ceramic and metal-ceramic fixed partial dentures. An electronic search for articles in the English language literature was performed using PubMed (MEDLINE). This literature review focused on research studies between 2010 and 2020 that performed clinical studies on tooth-supported fixed partial dentures with a mean follow-up of at least 3 years. All the studies, which analyzed the survival and complications of tooth-supported fixed partial dentures, were included. Thus, 14 studies reporting on 756 all-ceramic and 160 metal-ceramic fixed partial dentures met the inclusion criteria. A comparative analysis was carried out based on all the data existing in the studies included in this review. The metal-ceramic fixed partial dentures showed survival rates of 95% to 100% at 3-, 5-, and 10-year follow-up periods. Zirconia fixed partial dentures were reported to have survival rates of 81% to 100% at 3-, 5-, 9-, 10-year follow-up evaluations. The reinforced glass-ceramic fixed partial dentures showed survival rates of 70% to 93.35% at 5 years, while the alumina FPDs showed a survival rate of 68% at 3 years follow-up. The incidence of caries and loss of vitality were reported as higher for all-ceramic prostheses as compared to the metal-ceramic ones. A significant framework fracture was reported for glass-infiltrated alumina fixed partial dentures in comparison to metal-ceramic fixed partial dentures. All-ceramic and metal-ceramic restorations showed similar survival rates after 3 years, although all-ceramic restorations have problems with technical complications such as chipping, which can lead to framework fractures over time.
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Randomized clinical trial comparing monolithic and veneered zirconia three-unit posterior fixed partial dentures in a complete digital flow: three-year follow-up. Clin Oral Investig 2022; 26:4327-4335. [PMID: 35142924 PMCID: PMC9203772 DOI: 10.1007/s00784-022-04396-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
Objectives To evaluate and to compare the clinical performance and survival rate of posterior monolithic and veneered zirconia fixed partial dentures (FPDs). Material and methods Sixty 3-unit posterior FPDs were included in the study. The patients were randomly distributed into two groups (n = 30 each) to receive either a monolithic (Zenostar T, Wieland Dental) or veneered zirconia (IPS e.max ZirCAD, Ivoclar Vivadent) FPD. Each patient received only 1 FPD. Tooth preparations were scanned (Trios 3, 3Shape), designed (Dental System 2016, 3 Shape), milled (Zenotec CAM 3.2, Wieland Dental), and cemented with a resin cement. Technical and biological outcomes and periodontal parameters were assessed. Data analysis was made using the Friedman and the Wilcoxon signed-rank tests with the Bonferroni correction and the Mann–Whitney U test. Results The survival rate at 3 years was 100% for veneered and 90% for monolithic zirconia restorations. Three monolithic zirconia FPDs were lost because of biologic complications. The main complication in the veneered zirconia FPDs was the fracture of the veneering ceramic in 4 of the veneered zirconia FPDs. No fracture of the frameworks was observed in any of the groups. All restorations were assessed as satisfactory after 3 years. No differences in periodontal parameters were observed between the groups. Conclusions The results of this study suggest that monolithic zirconia and complete digital flow could be a viable alternative to veneered zirconia in the posterior regions. Clinical relevance The monolithic zirconia restorations with a digital workflow can be a viable alternative in posterior fixed partial dentures, with good periodontal outcomes. Clinical trial registration number ClinicalTrials.gov (Identifier NCT 04,879,498).
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Masking Abilities of Dental Cad/Cam Resin Composite Materials Related to Substrate and Luting Material. Polymers (Basel) 2022; 14:polym14030364. [PMID: 35160353 PMCID: PMC8838689 DOI: 10.3390/polym14030364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 12/05/2022] Open
Abstract
An outstanding treatment challenge related to aesthetic monolithic materials is to mask discolored substrates in aesthetic areas. The purpose of the study is to evaluate the substrate masking ability of different resin composite materials and the influence of their association with luting agents and substrates. Five types of 2M2 HT (high translucency) resin composite materials were selected: Vita Enamic [E] and four types of nanoparticle-filled composites Lava Ultimate [L], Cerasmart [C], Shofu HC [S], and Hyramic [H]. Resin composite Vita VM LC with different shades was used for the substrates: 2M2, 3M2, and CP2. Variolink Esthetic Try-inpastes neutral, light+, and warm+ colors were chosen to simulate the luting agent color. Optical parameters (TP (translucency), CR (contrast ratio), and OP (opalesce)) and color differences ΔE (chromatic difference) were calculated. Statistical analyses were performed to evaluate the comparisons between the groups and establish correlations. TP average values for all materials were in the range of 21.49–24.53. OP average values were in the rage of 6.31–7.85. OP is moderate positive correlated to TP and CR is negative and strong correlated to TP. Related to materials, average color changes decrease as following: E > H > C > L > S. Referring to the tryin material, warm colors induce marked color changes of the restoration. The differences of the color changes determined by all studied substrates are significant. For the final aesthetic aspect of the restoration, it is essential to consider the underlying dental structure, luting agent, and restoration material as a whole unit. The masking ability of the investigated resin matrix ceramic materials materials shows differences, the best behavior demonstrated Shofu HC and Lava Ultimate. Marked color changes are related to high chroma substrates. For substrates with a darker color, the association with warm try-in pastes lead to marked color changes, but with neutral and light try-in pastes at most perceivable.
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Ozkir SE, Bicer M, Deste G, Karakus E, Yilmaz B. Wear of monolithic zirconia against different CAD-CAM and indirect restorative materials. J Prosthet Dent 2021; 128:505-511. [PMID: 34059295 DOI: 10.1016/j.prosdent.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022]
Abstract
STATEMENT OF PROBLEM The wear of monolithic zirconia against enamel has been widely studied, but how zirconia affects different opposing restorative materials is not clear. PURPOSE The purpose of this in vitro study was to investigate the depth of wear and volumetric loss of different restorative materials opposed by monolithic zirconia. MATERIAL AND METHODS Sixty-six Ø10×3-mm specimens (n=11) were fabricated from monolithic zirconia, zirconia reinforced ceramic, lithium disilicate ceramic, feldspathic ceramic, ORMOCER, and ceramic optimized polymer. A 2-body pin-on-disk wear test was performed by using monolithic zirconia pins. The specimens were scanned with a noncontact profilometer after the tests. The scan parameters were a frame size area of 1.5×1.5 mm, frequency of 400 Hz, and scan sensitivity of 2 μm. After the evaluation of depth and volume loss, the specimens were analyzed with a scanning electron microscope. The Kruskal-Wallis test was used to analyze the differences in wear values across the specimen groups, and pairwise comparison tests were performed with a post hoc test (α=.05). RESULTS Maximum depth of wear was 257.55 ±18.88 μm for lithium disilicate ceramic, 295.36 ±14.46 μm for zirconia reinforced ceramic, 421.82 ±214.49 μm for ORMOCER, 333.73 ±79.09 μm for ceramic optimized polymer, 146.27 ±22.86 μm for feldspathic ceramic, and 41.55 ±5.04 μm for monolithic zirconia. The depth of wear was not significantly different among lithium disilicate, zirconia-reinforced ceramic, ORMOCER, and ceramic optimized polymer (P<.05). However, the depth of wear of monolithic zirconia and feldspathic ceramic was less than that of other materials (P<.001). Volume loss of lithium disilicate was 1.68 ±0.25 mm3, 1.08 ±0.35 mm3 for zirconia reinforced ceramic, 4.29 ±2.91 mm3 for ORMOCER, 2.46 ±0.63 mm3 for resin ceramic, 1.07 ±0.09 mm3 for feldspathic ceramic, and 0.19 ±0.02 mm3 for monolithic zirconia. Feldspathic ceramic and monolithic zirconia had significantly less volume loss than the other groups (P<.001), and the difference between them for volume loss was statistically insignificant (P>.05). CONCLUSIONS The tested ceramic-based materials had favorable wear resistance compared with the tested composite resin-based ones. However, the ceramics tended to crack formation than the composite resins.
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Affiliation(s)
- Serhat Emre Ozkir
- Associate Professor, Department of Prosthodontics, Faculty of Dentistry, Osmangazi University, Eskişehir, Turkey.
| | - Mehmet Bicer
- Research Assistant, Department of Prosthodontics, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Gonca Deste
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Uludag University, Bursa, Turkey
| | - Elif Karakus
- Research Assistant, Department of Prosthodontics, Faculty of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Burak Yilmaz
- Associate Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Associate Professor, Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio
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Saravi B, Vollmer A, Hartmann M, Lang G, Kohal RJ, Boeker M, Patzelt SBM. Clinical Performance of CAD/CAM All-Ceramic Tooth-Supported Fixed Dental Prostheses: A Systematic Review and Meta-Analysis. MATERIALS 2021; 14:ma14102672. [PMID: 34065202 PMCID: PMC8161295 DOI: 10.3390/ma14102672] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022]
Abstract
Although CAD/CAM ceramics present a promising alternative to metal-ceramic fixed dental prostheses, little is known about their mid- and long-term clinical performance. This systematic review aims to estimate the survival and success rates and describes the underlying complication characteristics for CAD/CAM tooth-supported zirconia- and lithium disilicate-based fixed dental prostheses (FDPs). We systematically searched MEDLINE and Web of Science to find relevant prospective studies with a follow-up of at least one year. We estimated pooled 1-, 5-, and 10-year survival and success rates by combining the collected data in a Poisson regression model. Descriptive statistics were conducted to evaluate the distribution of failures and complications in the included studies. Risk of bias for the included studies was assessed with an adapted checklist for single-arm trials. Pooled estimated 1-, 5-, and 10-year survival rates ranged from 93.80% to 94.66%, 89.67% to 91.1%, and 79.33% to 82.20%, respectively. The corresponding success rates excluding failures, but including any other types of intervention were 94.53% to 96.77%, 90.89% to 94.62%, and 81.78% to 89.25%. Secondary caries was the most frequent cause of failure, followed by chipping of the veneering. The most common cause of complication excluding failures but requiring intervention was chipping of the veneering. Risk of bias was generally acceptable for the included studies, with seven studies associated with low risk of bias, eight studies with a moderate risk of bias, and three studies with serious risk of bias. The current meta-analysis on CAD/CAM-supported FDPs revealed satisfying survival and success rates for up to 10 years of exposure. More prospective studies focusing on long-term performance are needed to strengthen the evidence currently available in the literature.
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Affiliation(s)
- Babak Saravi
- Medical Center—University of Freiburg, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany;
- Correspondence:
| | - Andreas Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany;
| | - Maja Hartmann
- Private Practice, Kantstraße 10, 60316 Frankfurt am Main, Germany;
| | - Gernot Lang
- Medical Center—University of Freiburg, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany;
| | - Ralf-Joachim Kohal
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany; (R.-J.K.); (S.B.M.P.)
| | - Martin Boeker
- Medical Center—University of Freiburg, Institute of Medical Biometry and Medical Statistics, Faculty of Medicine, University of Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany;
| | - Sebastian B. M. Patzelt
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany; (R.-J.K.); (S.B.M.P.)
- Private Practice, Am Dorfplatz 3, 78658 Zimmern o.R., Germany
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Pontevedra P, Lopez‐Suarez C, Pelaez J, Garcia‐Serdio S, Suarez MJ. Prospective Clinical Evaluation of Posterior Monolithic Zirconia Fixed Partial Dentures Using a Complete Digital Workflow: Two‐Year Follow‐Up. J Prosthodont 2020; 30:298-304. [DOI: 10.1111/jopr.13251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Paula Pontevedra
- Department of Conservative Dentistry and Buccofacial Prostheses Faculty of Odontology, University Complutense of Madrid Madrid Spain
| | - Carlos Lopez‐Suarez
- Department of Conservative Dentistry and Buccofacial Prostheses Faculty of Odontology, University Complutense of Madrid Madrid Spain
| | - Jesus Pelaez
- Department of Conservative Dentistry and Buccofacial Prostheses Faculty of Odontology, University Complutense of Madrid Madrid Spain
| | - Sara Garcia‐Serdio
- Department of Conservative Dentistry and Buccofacial Prostheses Faculty of Odontology, University Complutense of Madrid Madrid Spain
| | - Maria J Suarez
- Department of Conservative Dentistry and Buccofacial Prostheses Faculty of Odontology, University Complutense of Madrid Madrid Spain
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A Novel Full-Digital Protocol (SCAN-PLAN-MAKE-DONE ®) for the Design and Fabrication of Implant-Supported Monolithic Translucent Zirconia Crowns Cemented on Customized Hybrid Abutments: A Retrospective Clinical Study on 25 Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030317. [PMID: 30678357 PMCID: PMC6388107 DOI: 10.3390/ijerph16030317] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 02/06/2023]
Abstract
Purpose: To present a novel, full-digital protocol for the design and fabrication of implant-supported monolithic translucent zirconia crowns cemented on customized hybrid abutments. Methods: The present retrospective clinical study was based on data from patients who had been treated with single Morse-taper connection implants (Exacone®, Leone Implants, Florence, Italy) and were prosthetically restored with monolithic translucent zirconia crowns, cemented on customized hybrid abutments. The full-digital protocol (SCAN-PLAN-MAKE-DONE®) consisted of 8 phases: (1) intraoral scan of the implant position with scanbody; (2) computer-assisted design (CAD) of the individual abutment (saved as “supplementary abutment design” in external folder) and temporary crown; (3) milling of the individual zirconia abutment and of the temporary polymethyl-methacrylate (PMMA) crown, with extraoral cementation of the zirconia abutment on the relative titanium bonding base, to generate an individual hybrid abutment; (4) clinical application of the individual hybrid abutment and cementation of the temporary PMMA crown; (5) two months later, intraoral scan of the individual hybrid abutment in position; (6) CAD of the final crown with margin line design on the previously saved “supplementary abutment design”, superimposed on the second scan of the abutment in position; (7) milling of the final crown in monolithic translucent zirconia, sintering, and characterization; and (8) clinical application of the final crown. All patients were followed for a period of 1 year. The primary outcomes of this study were the marginal adaptation of the final crown (checked clinically and radiographically), the quality of occlusal and interproximal contact points at delivery, and the aesthetic integration; the secondary outcomes were the 1-year survival and success of the implant-supported restoration. An implant-supported restoration was considered successful in the absence of any biological or prosthetic complication, during the entire follow-up period. Results: In total, 25 patients (12 males, 13 females; 26–74 years of age; mean age 51.1 ± 13.3 years) who had been restored with 40 implant-supported monolithic translucent zirconia crowns were included in this study. At delivery, the marginal adaptation was perfect for all crowns. However, there were occlusal issues (2/40 crowns: 5%), interproximal issues (1/40 crowns: 2.5%), and aesthetic issues (1/40 crowns: 2.5%). The overall incidence of issues at delivery was therefore 10% (4/40 crowns). At 1 year, one implant failed; thus the survival of the restorations was 97.5% (39/40 crowns in function). Among the surviving implant-supported restorations, three experienced complications (one loss of connection between the hybrid abutment and the implant, one decementation of the zirconia abutment, and one decementation of the zirconia crown). The success of restorations amounted to 92.4%. Conclusions: The restoration of single Morse-taper connection implants with monolithic translucent zirconia crowns cemented on customized hybrid abutments via the novel SCAN-PLAN-MAKE-DONE® full-digital protocol seems to represent a reliable treatment option. However, further studies on a larger number of patients and dealing with different prosthetic restorations (such as implant-supported fixed partial prostheses) are needed to confirm the validity of this protocol.
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Takeuchi Y, Koizumi H, Furuchi M, Sato Y, Ohkubo C, Matsumura H. Use of digital impression systems with intraoral scanners for fabricating restorations and fixed dental prostheses. J Oral Sci 2018; 60:1-7. [DOI: 10.2334/josnusd.17-0444] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Yoshimasa Takeuchi
- Department of Comprehensive Dentistry and Clinical Education, Nihon University School of Dentistry
- Division of Dental Education, Dental Research Center, Nihon University School of Dentistry
| | - Hiroyasu Koizumi
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
- Division of Advanced Dental Treatment, Dental Research Center, Nihon University School of Dentistry
| | - Mika Furuchi
- Department of Comprehensive Dentistry and Clinical Education, Nihon University School of Dentistry
- Division of Dental Education, Dental Research Center, Nihon University School of Dentistry
| | - Yohei Sato
- Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine
| | - Chikahiro Ohkubo
- Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine
| | - Hideo Matsumura
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
- Division of Advanced Dental Treatment, Dental Research Center, Nihon University School of Dentistry
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Mangano F, Gandolfi A, Luongo G, Logozzo S. Intraoral scanners in dentistry: a review of the current literature. BMC Oral Health 2017; 17:149. [PMID: 29233132 PMCID: PMC5727697 DOI: 10.1186/s12903-017-0442-x] [Citation(s) in RCA: 314] [Impact Index Per Article: 44.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraoral scanners (IOS) are devices for capturing direct optical impressions in dentistry. The purpose of this narrative review on the use of IOS was to: (1) identify the advantages/disadvantages of using optical impressions compared to conventional impressions; (2) investigate if optical impressions are as accurate as conventional impressions; (3) evaluate the differences between the IOS currently available commercially; (4) determine the current clinical applications/limitations in the use of IOS. METHODS Electronic database searches were performed using specific keywords and MeSH terms. The searches were confined to full-text articles written in English and published in peer-reviewed journals between January 2007 and June 2017. RESULTS One hundred thirty-two studies were included in the present review; among them, 20 were previous literature reviews, 78 were in vivo clinical studies (6 randomized controlled/crossover trials, 31 controlled/comparative studies; 24 cohort studies/case series; 17 case reports) and 34 were in vitro comparative studies. CONCLUSIONS Optical impressions reduce patient discomfort; IOS are time-efficient and simplify clinical procedures for the dentist, eliminating plaster models and allowing better communication with the dental technician and with patients; however, with IOS, it can be difficult to detect deep margin lines in prepared teeth and/or in case of bleeding, there is a learning curve, and there are purchasing and managing costs. The current IOS are sufficiently accurate for capturing impressions for fabricating a whole series of prosthetic restorations (inlays/onlays, copings and frameworks, single crowns and fixed partial dentures) on both natural teeth and implants; in addition, they can be used for smile design, and to fabricate posts and cores, removable partial prostheses and obturators. The literature to date does not support the use of IOS in long-span restorations with natural teeth or implants. Finally, IOS can be integrated in implant dentistry for guided surgery and in orthodontics for fabricating aligners and custom-made devices.
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Affiliation(s)
- Francesco Mangano
- Department of Medicine and Surgery, Dental School, University of Varese, Varese, Italy.
| | | | - Giuseppe Luongo
- Department of Oral and Maxillofacial Surgery, Federico II University, Naples, Italy
| | - Silvia Logozzo
- Department of Engineering, University of Perugia, Perugia, Italy.,V-GER srl, Department of Research and Development, Bologna, Italy
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Joda T, Zarone F, Ferrari M. The complete digital workflow in fixed prosthodontics: a systematic review. BMC Oral Health 2017; 17:124. [PMID: 28927393 PMCID: PMC5606018 DOI: 10.1186/s12903-017-0415-0] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/13/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The continuous development in dental processing ensures new opportunities in the field of fixed prosthodontics in a complete virtual environment without any physical model situations. The aim was to compare fully digitalized workflows to conventional and/or mixed analog-digital workflows for the treatment with tooth-borne or implant-supported fixed reconstructions. METHODS A PICO strategy was executed using an electronic (MEDLINE, EMBASE, Google Scholar) plus manual search up to 2016-09-16 focusing on RCTs investigating complete digital workflows in fixed prosthodontics with regard to economics or esthetics or patient-centered outcomes with or without follow-up or survival/success rate analysis as well as complication assessment of at least 1 year under function. The search strategy was assembled from MeSH-Terms and unspecific free-text words: {(("Dental Prosthesis" [MeSH]) OR ("Crowns" [MeSH]) OR ("Dental Prosthesis, Implant-Supported" [MeSH])) OR ((crown) OR (fixed dental prosthesis) OR (fixed reconstruction) OR (dental bridge) OR (implant crown) OR (implant prosthesis) OR (implant restoration) OR (implant reconstruction))} AND {("Computer-Aided Design" [MeSH]) OR ((digital workflow) OR (digital technology) OR (computerized dentistry) OR (intraoral scan) OR (digital impression) OR (scanbody) OR (virtual design) OR (digital design) OR (cad/cam) OR (rapid prototyping) OR (monolithic) OR (full-contour))} AND {("Dental Technology" [MeSH) OR ((conventional workflow) OR (lost-wax-technique) OR (porcelain-fused-to-metal) OR (PFM) OR (implant impression) OR (hand-layering) OR (veneering) OR (framework))} AND {(("Study, Feasibility" [MeSH]) OR ("Survival" [MeSH]) OR ("Success" [MeSH]) OR ("Economics" [MeSH]) OR ("Costs, Cost Analysis" [MeSH]) OR ("Esthetics, Dental" [MeSH]) OR ("Patient Satisfaction" [MeSH])) OR ((feasibility) OR (efficiency) OR (patient-centered outcome))}. Assessment of risk of bias in selected studies was done at a 'trial level' including random sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other bias using the Cochrane Collaboration tool. A judgment of risk of bias was assigned if one or more key domains had a high or unclear risk of bias. An official registration of the systematic review was not performed. RESULTS The systematic search identified 67 titles, 32 abstracts thereof were screened, and subsequently, three full-texts included for data extraction. Analysed RCTs were heterogeneous without follow-up. One study demonstrated that fully digitally produced dental crowns revealed the feasibility of the process itself; however, the marginal precision was lower for lithium disilicate (LS2) restorations (113.8 μm) compared to conventional metal-ceramic (92.4 μm) and zirconium dioxide (ZrO2) crowns (68.5 μm) (p < 0.05). Another study showed that leucite-reinforced glass ceramic crowns were esthetically favoured by the patients (8/2 crowns) and clinicians (7/3 crowns) (p < 0.05). The third study investigated implant crowns. The complete digital workflow was more than twofold faster (75.3 min) in comparison to the mixed analog-digital workflow (156.6 min) (p < 0.05). No RCTs could be found investigating multi-unit fixed dental prostheses (FDP). CONCLUSIONS The number of RCTs testing complete digital workflows in fixed prosthodontics is low. Scientifically proven recommendations for clinical routine cannot be given at this time. Research with high-quality trials seems to be slower than the industrial progress of available digital applications. Future research with well-designed RCTs including follow-up observation is compellingly necessary in the field of complete digital processing.
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Affiliation(s)
- Tim Joda
- Section for Digital Reconstructive Technology + Implant Dentistry [DiRecT + ID], Department of Reconstructive Dentistry, School of Dental Medicine, University of Bern, Freiburgstr. 7, 3010 Bern, Switzerland
- Department of Reconstructive Dentistry, University Center for Dental Medicine, Basel, Switzerland
| | - Fernando Zarone
- Department of Prosthodontics, School of Dental Medicine, University of Napoli, Naples, Italy
| | - Marco Ferrari
- Department of Prosthodontics & Dental Materials, School of Dental Medicine, University of Siena, Siena, Italy
- Department of Restorative Dentistry, School of Dental Medicine, University of Leeds, Leeds, UK
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A Three-Year Retrospective Study on Survival of Ceramic-Veneered Zirconia (Y-TZP) Fixed Dental Prostheses Performed in Private Practices. Int J Dent 2017; 2017:9618306. [PMID: 28713427 PMCID: PMC5496317 DOI: 10.1155/2017/9618306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/15/2017] [Indexed: 01/02/2023] Open
Abstract
Objectives The aim of this retrospective study was to evaluate the three-year clinical outcome for ceramic-veneered zirconia fixed dental prostheses (FDPs). Methods All patients who were treated with ceramic-veneered zirconia FDPs, in three private practices in Sweden, during the period June 2003 to April 2007 were included. Case records from 151 patients, treated with a total of 184 zirconia FDPs (692 units), were analysed for clinical data. All complications noted in the charts were registered and compared to definitions for success and survival and statistical analysis was performed using the Kaplan-Meier method and a Cox regression model. Results In total, 32 FDPs in 31 patients experienced some type of complication (17.4% of FDPs, 20.5% of patients). Core fractures occurred in two (1.1%) FDPs. Two (1.1%) FDPs or 0.6% of units showed adhesive veneer fractures. Cohesive veneer fractures occurred in 10 (5.4%) FDPs (1.6% of units). The three-year cumulative success and survival rates (CSR) were 82.3% and 95.2%, respectively. Conclusions Ceramic-veneered zirconia is a promising alternative to metal-ceramic FDPs, even in the posterior area. However, the higher survival rate of metal-ceramic FDPs should be noted and both dentists and patients must be aware of the risks of complications.
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In vitro evaluation of marginal discrepancy of monolithic zirconia restorations fabricated with different CAD-CAM systems. J Prosthet Dent 2016; 117:762-766. [PMID: 27836145 DOI: 10.1016/j.prosdent.2016.09.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 11/21/2022]
Abstract
STATEMENT OF PROBLEM Dental laboratories use different computer-aided design and computer-aided manufacturing (CAD-CAM) systems to fabricate fixed prostheses; however, limited evidence is available concerning which system provides the best marginal discrepancy. PURPOSE The purpose of this in vitro study was to evaluate the marginal fit of 5 different monolithic zirconia restorations milled with different CAD-CAM systems. MATERIAL AND METHODS Thirty monolithic zirconia crowns were fabricated on a custom-designed stainless steel die and were divided into 5 groups according to the type of monolithic zirconia crown and the CAD-CAM system used: group TZ, milled with an MCXL milling machine; group CZ, translucent zirconia milled with a motion milling machine; group ZZ, zirconia milled with a dental milling unit; group PZ, translucent zirconia milled with a zirconia milling unit; and group BZ, solid zirconia milled using an S1 VHF milling machine. The marginal fit was measured with a binocular microscope at an original magnification of ×100. The results were tabulated and statistically analyzed with 1-way ANOVA and post hoc surface range test, and pairwise multiple comparisons were made using Bonferroni correction (α=.05). RESULTS The type of CAD-CAM used affected the marginal fit of the monolithic restoration. The mean (±SD) highest marginal discrepancy was recorded in group TZI at 39.3 ±2.3 μm, while the least mean marginal discrepancy was recorded in group IZ (22.8 ±8.9 μm). The Bonferroni post hoc test showed that group TZI was significantly different from all other groups tested (P<.05). CONCLUSIONS Within the limitation of this in vitro study, all tested CAD-CAM systems produced monolithic zirconia restorations with clinically acceptable marginal discrepancies; however, the CAD-CAM system with the 5-axis milling unit produced the best marginal fit.
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Rödiger M, Heinitz A, Bürgers R, Rinke S. Fitting accuracy of zirconia single crowns produced via digital and conventional impressions-a clinical comparative study. Clin Oral Investig 2016; 21:579-587. [PMID: 27469102 DOI: 10.1007/s00784-016-1924-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/21/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study focused on the clinical investigation of the internal and marginal fit of CAD/CAM-fabricated zirconia single crowns produced via conventional and digital impression techniques. MATERIALS AND METHODS In a private practice, 20 molar teeth, one from each of 20 patients, were prepared with a circumferential 1.0-mm deep chamfer and an occlusal reduction of 1.5 mm. Conventional impression (CI) taking with a polyvinylsiloxane material (Aquasil Monophase + Aquasil XLV; Dentsply, Konstanz, Germany) and intraoral scanning (IS) (Cara TRIOS; Heraeus, Hanau, Germany) of each of the preparations was performed, and then two respective zirconia copings per tooth were produced (20 crowns per group). The marginal and internal fit of the restorations was evaluated employing a replica technique. For statistical analysis, a pairwise comparison (Wilcoxon rank test) was performed. RESULTS Zirconia single crowns produced with the IS technique revealed a statistically significant better precision of internal fit only in specific areas (chamfer area/occlusal area). The evaluation of marginal fit showed no significant differences between the two groups. All restorations of both groups offered internal and marginal gaps within the postulated clinical tolerance ranges. CONCLUSIONS CAD/CAM-fabricated zirconia single crowns produced with CI and IS techniques offer adequate marginal and internal precision. However, the IS technique provides lower internal gaps in some specific areas. CLINICAL RELEVANCE The clinical precision of fit of restorations produced with a CI and an IS technique appeared to be equivalent. Therefore, the IS technique can be rated as a suitable alternative for the manufacturing of single crowns.
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Affiliation(s)
- Matthias Rödiger
- Department of Prosthodontics, University Medical Center Goettingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Arthur Heinitz
- Department of Prosthodontics, University Medical Center Goettingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Ralf Bürgers
- Department of Prosthodontics, University Medical Center Goettingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Sven Rinke
- Department of Prosthodontics, University Medical Center Goettingen, Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
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From Guided Surgery to Final Prosthesis with a Fully Digital Procedure: A Prospective Clinical Study on 15 Partially Edentulous Patients. Int J Dent 2016; 2016:7358423. [PMID: 27493665 PMCID: PMC4963589 DOI: 10.1155/2016/7358423] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 06/19/2016] [Indexed: 01/20/2023] Open
Abstract
Scope. To demonstrate guided implant placement and the application of fixed, implant-supported prosthetic restorations with a fully digital workflow. Methods. Over a 2-year period, all patients with partial edentulism of the posterior maxilla, in need of fixed implant-supported prostheses, were considered for inclusion in this study. The protocol required intraoral scanning and cone beam computed tomography (CBCT), the superimposition of dental-gingival information on bone anatomy, surgical planning, 3D-printed teeth-supported surgical templates, and modelling and milling of polymethylmethacrylate (PMMA) temporaries for immediate loading. After 3 months, final optical impression was taken and milled zirconia frameworks and 3D-printed models were fabricated. The frameworks were veneered with ceramic and delivered to the patients. Results. Fifteen patients were selected for this study. The surgical templates were stable. Thirty implants were placed (BTK Safe®, BTK, Vicenza, Italy) and immediately loaded with PMMA temporaries. After 3 months, the temporaries were replaced by the final restorations in zirconia-ceramic, fabricated with a fully digital process. At 6 months, none of the patients reported any biological or functional problems with the implant-supported prostheses. Conclusions. The present procedure for fully digital planning of implants and short-span fixed implant-supported restorations has been shown to be reliable. Further studies are needed to validate these results.
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