Accelerated techniques for a post and core and a crown restoration with intraoral digital scanners and CAD/CAM and rapid prototyping

Evaluation of the accuracy of direct intraoral scanner impressions for digital post and core in various post lengths: An in-vitro study

STATEMENT OF PROBLEM

Despite the growing utilization of direct intraoral scanners (IOSs) in dentistry, there is a scarcity of research investigating their accuracy, specifically in post and core. Few studies have conducted comprehensive three-dimensional assessments and comparisons of IOSs with the conventional impression technique, particularly in different post space lengths.

PURPOSE

The purpose of this in vitro study was to digitally assess the accuracy of direct intraoral scanner (IOS) impressions for different post space lengths, specifically 6, 8, and 10 mm.

MATERIALS AND METHODS

A total of 45 typodont teeth (maxillary central incisors) were selected for this study. The teeth underwent endodontic treatment and were divided into three subgroups, each with 15 teeth, based on the desired post space lengths: 6, 8, and 10 mm. Intraoral scans of all specimens were acquired directly using the CEREC Primescan intraoral scanners by two trained examiners. The obtained scan data were compared with conventional impressions obtained using light and heavy bodies of polyvinyl siloxane (PVS). As a control, the conventional impressions were subsequently scanned using an inEos X5a lab scanner. The accuracy of the digital scans was evaluated in the coronal, middle, and apical thirds using the Geomagic Control X software. Statistical analysis was performed using Bonferroni Post-hoc and One-way ANOVA tests to analyze the data.

RESULTS

The overall mean root mean square (RMS) deviations for the different post lengths across the three thirds groups were 58, 81, and 101 μm for the 6, 8, and 10 mm subgroups, respectively. There were no statistically significant differences in the accuracy of the coronal and middle thirds among all subgroups (p > 0.5). However, in the apical third, the 10 mm subgroup exhibited a significantly lower accuracy (163 μm) compared to the 6 mm (96 μm) and 8 mm (131 μm) subgroups (p < 0.05). These results suggest that while the accuracy of intraoral scans using direct IOS impressions was consistent in the coronal and middle thirds regardless of the post length, there was a noticeable decrease in accuracy in the apical third, particularly with longer post lengths.

CONCLUSION

Considering the limitations of this in vitro study, chairside direct IOS impressions offer a viable and clinically acceptable alternative to the conventional impression technique for post space lengths of 6 and 8 mm. However, as the post space length preparation increases, the accuracy of IOS decreases.

CLINICAL SIGNIFICANCE

The Chairside direct IOS enables expedited and efficient digital impression capture within the root canal, ensuring acceptable accuracy for intracanal post length preparation of up to 8 mm.

Digital Workflow for Producing Hybrid Posts and Cores

A novel and straightforward digital workflow is described to aid clinicians in producing in-office hybrid posts and cores. The method is based on scanning and using the basic module of a computer-assisted design and computer-assisted manufacturing (CAD-CAM) software program for dental applications. The applicability of the technique in a digital workflow is the simplicity of in-office production of a hybrid post and core that can be delivered to the patient in the same day.

In vitro Results of Scanning Technique on Assessing Cement Thickness and Interfacial Nanoleakage of Luted CAD/CAM-Fabricated Fiber Posts

Background:

Fiber posts are broadly used due to their good esthetics and elasticity close to that of dentin, which allows for uniform stress distribution within a root and lowers the possibility of nonrestorable root fractures.

Aim and Objectives:

The study assessed the layer of cement thickness and interfacial nanoleakage of luted fiber posts which were fabricated with CAD/CAM technology following direct scanning of the post space (DS) method, scanning of a polyether impression of the post space (IS), and scanning of a plaster model of the post space (MS).

Methodology:

Ninety premolars were chosen randomly and were assigned to three groups according to the scanning technique. Posts were computer designed and milled from experimental fiber-reinforced composite blocks.

Results:

The mean and standard deviation values of cement thickness, respectively, were: DS 172 ± 39 = m; IS 199 ± 55 = m, and MS MPa 272 ± 81 = m. The fiber posts fabricated following DS technique demonstrated superior performance compared to posts fabricated upon IS and MS, in terms of the post retention. The cement thickness did not differ between DS and IS, whereas in MS group, the cement layer was significantly thicker than in the remaining two groups. The scanning technique did not influence the sealing ability, as all groups showed comparable nanoleakage.

Conclusion:

Fiber posts fabricated following DS technique demonstrated superior performance. Furthermore, scanning technique did not influence the sealing ability, as all groups showed comparable nanoleakage.

Effects of scanning technique on in vitro performance of CAD/CAM-fabricated fiber posts

This study assessed push-out strength, cement layer thickness, and interfacial nanoleakage of luted fiber posts fabricated with computer-aided design/computer-assisted manufacture (CAD/CAM) technology after use of 1 of 3 scanning techniques, namely, direct scanning of the post space (DS), scanning of a polyether impression of the post space (IS), and scanning of a plaster model of the post space (MS). Thirty premolars were randomly assigned to three groups corresponding to the scanning technique. Posts were computer-designed and milled from experimental fiber-reinforced composite blocks. The mean (±SD) values for push-out strength and cement thickness were 17.1 ± 7.7 MPa and 162 ± 24 μm, respectively, for DS, 10.7 ± 4.6 MPa and 187 ± 50 μm for IS, and 12.0 ± 7.2 MPa and 258 ± 78 μm for MS specimens. Median (interquartile range) interfacial nanoleakage scores were 3 (2-4) for DS, 2.5 (2-4) for IS, and 3 (2-4) for MS. Post retention was better for fiber posts fabricated by DS technique than for those fabricated by IS and MS. Cement thickness did not differ between DS and IS specimens, but the cement layer was significantly thicker in the MS group than in the other two groups. Scanning technique did not affect sealing ability, as the three groups had comparable nanoleakage values.

Intraoral scanners in dentistry: a review of the current literature

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.

Evaluation of the flexural strength and microhardness of provisional crown and bridge materials fabricated by different methods

Purpose:

The purpose of this study was to evaluate and compare the flexural strength and microhardness of provisional restorative materials fabricated utilizing rapid prototyping (RP), Computer Assisted Designing and Computer Assisted Milling (CAD-CAM) and conventional method.

Materials and Methods:

Twenty specimens of dimensions 25 mm × 2 mm × 2 mm (ADA-ANSI specification #27) were fabricated each using: (1) Three dimensional (3D) printed light-cured micro-hybrid filled composite by RP resin group, (2) a milled polymethyl methacrylate (CH) using CAD-CAM (CC resin group), and (3) a conventionally fabricated heat activated polymerized CH resin group. Flexural strength and microhardness were measured and values obtained were evaluated.

Results:

The measured mean flexural strength values (MegaPascals) were 79.54 (RP resin group), 104.20 (CC resin group), and 95.58 (CH resin group). The measured mean microhardness values (Knoop hardness number) were 32.77 (RP resin group), 25.33 (CC resin group), and 27.36 (CH resin group). The analysis of variance (ANOVA) test shows that there is statistically significant difference in the flexural strength values of the three groups (P < 0.05). According to the pairwise comparison of Tukey's honest significant difference (HSD) test, flexural strength values of CC resin group and CH resin group were higher and statistically significant than those of the RP resin group (P < 0.05). However, there was no significant difference between flexural strength values of CC resin and CH resin group (P = 0.64). The difference in microhardness values of the three groups was statistically significant according to ANOVA as well as the intergroup comparison done using the Tukey's HSD (post hoc) test (P < 0.05).

Conclusions:

CC-based CH had the highest flexural strength whereas RP-based 3D printed and light cured micro-hybrid filled composite had the highest microhardness.

Comparison of fracture resistance between cast, CAD/CAM milling, and direct metal laser sintering metal post systems

PURPOSE

The purpose of this study was to compare the fracture resistance of Co-Cr post-cores fabricated with 3 different techniques: traditional casting (TC), computer-aided design and manufacturing (CAD/CAM) milling (CCM) and direct metal laser sintering (DMLS).

METHODS

Forty intact human mandibular premolar were endodontically treated. The roots were then randomly divided into four groups according to the post systems: the control group was only filled with gutta percha. Co-Cr metal posts were fabricated with TC, CCM and DMLS in the other three groups. The posts were luted with a resin cement and subjected to compression test at a crosshead speed of 1mm/min. The statistical analysis of the data was performed using one-way analysis of variance (ANOVA) and multiple comparison post hoc Tukey tests (α=.05). The samples were examined under a stereomicroscope with ×20 magnification for the evaluation of the fracture types.

RESULTS

The mean fracture loads were 432.69 N for control, 608.89 N for TC, 689.40 N for DMLS and 959.26 N for CCM. One-way ANOVA revealed significant difference between the groups (p<0.01). In the post hoc Tukey test, there were significant differences between groups except DMLS and TC.

CONCLUSION

While Co-Cr posts fabricated by TC and DMLS systems performed similarly in terms of fracture resistance, posts fabricated by CCM techniques showed higher fracture resistance values.

SIGNIFICANCE

Co-Cr metal posts fabricated by CCM and DMLS could be an alternative to TC processing in daily clinical application.