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

Five years of radiographic evaluation for the peri-implant bone changes of all-on-four implant prostheses constructed from different framework materials using different digital construction techniques

BACKGROUND

There is insufficient evidence recommending a framework material and a CAD/CAM manufacturing technique for mandibular implant-supported prostheses. The study objective was to evaluate the clinical application of different materials and construction techniques used for mandibular All-on-4 prosthesis on circumferential peri-implant bony changes after 5 years.

METHODS

Thirty-six male patients with all-on-4 mandibular implant-supported prostheses were recalled and divided into three groups. Group PK (patients with frameworks milled from PEEK blocks), Group PSM (patients with frameworks milled from soft metal blocks), and Group SLM (patients with frameworks constructed with additive manufacturing; selective laser melting). The circumferential bone level on all implant faces was assessed with a CBCT. Two-way repeated measures ANOVA was used to compare vertical bone loss (VBL) and horizontal bone loss (HBL) between different groups, implant positions, and observation times followed by Tukey's multiple comparisons.

RESULTS

For all observation times, there was a significant difference in VBL between groups for both anterior and posterior implants (P < .001). For anterior implants, group PSM showed the lowest VBL while group PK showed the highest for anterior and posterior implants. For all groups, HBL significantly increased after 5 years for both anterior and posterior implants (P < .001). For anterior implants, group PSM showed the highest HBL. For posterior implants, group PK and SLM showed the highest.

CONCLUSION

Within the study's limitations, mandibular implant-supported fixed frameworks fabricated with either milling from PEEK or soft metal blocks, or additive manufacturing (laser melting technology) exhibited significant vertical and horizontal bone height changes after 5 years.

CLINICAL TRIAL REGISTRY NUMBER

(NCT06071689) (11/10/2023).

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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.

Effect of lamination layer thickness and abutment preparation on the fit of Co-Cr multi-unit prostheses fabricated by additive manufacturing: An in vitro study

STATEMENT OF PROBLEM

Selective laser melting has been increasingly used in the fabrication of metal-ceramic prostheses. The lamination layer thickness may influence the fit of the restoration. However, data regarding its impact remain scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal and internal fit of cobalt-chromium (Co-Cr) 3-unit frameworks fabricated by additive manufacturing with different melting layer thicknesses on different abutments.

MATERIAL AND METHODS

The first right maxillary premolar and molar from a typodont were prepared with a circumferential 1.2-mm chamfer, 2-mm occlusal reduction, and total taper of 8 degrees to receive 3-unit fixed partial dentures. After framework design, the data were sent to a laser machine, and 30 specimens were fabricated from Co-Cr metal powder (Mediloy S-Co) by selective laser melting. Specimens were assigned to 3 groups (n=10) with different lamination layer thicknesses of 25 (L25), 50 (L50), and 100 (L100) μm. Marginal fit and internal fit were evaluated. Results were compared among layer thickness groups and abutments. Data were compared by using the Levene test, t test, and ANOVA (α=.05).

RESULTS

A statistical difference was found between different layer thickness groups (P=.016), but not between abutments (P=.429). On the abutment level, significant difference was found in the gap values for the molars (P=.049) between layer thickness groups, but not for the premolars (P=.126). Group L25 reported the smallest mean discrepancy values, and group L100 reported the highest, with statistical difference found between group L100 and groups L25 (P<.001) and L50 (P<.025), but not between groups L25 and L50 (P=.094).

CONCLUSIONS

The lamination layer thickness affected the adaptation of the metal frameworks. Framework fit did not significantly differ between abutments.

Clinical performance of polymer frameworks in dental prostheses: A systematic review

STATEMENT OF PROBLEM

High-performance polymers including polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) have been used as substitutes for metal frameworks in dental prostheses. However, the clinical performance of polymer-based frameworks is still uncertain.

PURPOSE

The purpose of this systematic review was to compare the clinical performance of PEEK and PEKK with that of metal frameworks for different dental prostheses.

MATERIAL AND METHODS

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases and non-peer-reviewed literature (without language or follow-up restrictions) were searched for studies conducted before February 2022. Only clinical studies, either randomized clinical trials (RCTs) or nonrandomized clinical trials (N-RCTs), comparing the clinical performance of polymer and metal frameworks were included. The risk of bias and certainty of the evidence were assessed with the RoB 2.0, ROBINS-I, and GRADE. Biologic (plaque and gingival indices, probing depth, bleeding scores, implant stability quotient, marginal bone loss) and mechanical outcomes (ridge base relation, prosthetic marginal gap, and fracture) were assessed.

RESULTS

Only 9 studies (7 RCTs and 2 N-RCTs) were included, all with moderate to serious risk of bias and low to very low certainty of evidence. No meta-analysis was possible, but qualitative analysis revealed lower plaque and gingival indices, probing depth, and marginal bone loss, with higher survival rates for implant-supported fixed prostheses and overdentures fabricated with PEEK than for metal frameworks. No significant differences were found between groups for removable partial dentures. The marginal fit of PEEK frameworks was also better for single crowns. Three fractures were reported in the 3 PEKK fixed dental prostheses with cantilevers.

CONCLUSIONS

PEEK and PEKK seem to be promising materials for dental prostheses, with acceptable response from the periodontal tissue. However, further well-designed studies are necessary to better understand their clinical and long-term limitations.

Finite Element Analysis: Connector Designs and Pontic Stress Distribution of Fixed Partial Denture Implant-Supported Metal Framework

This virtual study was designed to evaluate the stress-deformation of a metal fixed partial dentures (FPDs) pontic under different loads using two different connectors. The STL file was generated for a RPD of two implant-supported restorations. The Co-Cr metal substructure was designed with two types of connector design. The pontic is connected to implant-supported crowns with square and round shape connectors. This study was designed for a cementless-retained implant-supported FPD. Finite element modeling (FEM) is used to assess the stress and deformation of the pontic within a metal substructure as the FEM might provide virtual values that could have laboratory and clinical relevance. The Co-Cr alloy mechanical properties like the Poisson ratio and modulus of elasticity were based on the parameters of the three-dimensional structure additive method. Nonparametric analyses (Mann-Whitney U test) was used. The use of square or round connectors often resulted in non-significant changes in stress, and deformation under either three or each loaded point on the occlusal surface of a pontic (P > 0.05). However, the deformation revealed distinct variations between loads of the three points compared to each loaded point (P ≤ 0.05). According to this study data, the pontic occlusal surface appears to be the same in stress and deformation under different loads depending on whether square or round connectors are used. While at the same connector designs, the pontic occlusal surface deformed significantly at three loaded points than it did at each point.

Digital measurement method for comparing the absolute marginal discrepancy of three-unit ceramic fixed dental prostheses fabricated using conventional and digital technologies

BACKGROUND

In clinical practice, control of the marginal fit of fixed dental prostheses is hindered by evaluation method, which needs to be further improved to increase its clinical applicability. This study aimed to quantitatively analyze the absolute marginal discrepancy of three-unit ceramic fixed dental prostheses fabricated by conventional and digital technologies using a digital measurement method based on the digital impression technology and open source software.

METHODS

A digital workflow and the conventional impression combined with the lost-wax heat-pressed technique were adopted to separately fabricate 10 glass ceramic fixed dental prostheses. Three-dimensional data for the abutments, fixed dental prostheses, and fixed dental prostheses seated on the abutments, were obtained using a dental scanner. The two datasets were aligned using registration technology, specifically "multi-points registration" and "best fit alignment," by reverse engineering software. Subsequently, the three-dimensional seated fit between the fixed dental prostheses and abutments were reconstructed. The margin of the abutment and crown was extracted using edge-sharpening and other functional modules, and the absolute marginal discrepancy was measured by the distance between the margin of the abutment and crown. One-way analysis of variance was used to statistically analyze the measurement results.

RESULTS

Using the digital measurement method, the mean value of absolute marginal discrepancy for fixed dental prostheses fabricated by the conventional method was 106.69 ± 6.46 μm, and that fabricated by the digital workflow was 102.55 ± 6.96 μm. The difference in the absolute marginal discrepancy of three-unit all-ceramic fixed dental prostheses fabricated using the two methods was not statistically significant (p > 0.05).

CONCLUSIONS

The digital measurement method for absolute marginal discrepancy was preliminarily established based on open source software and applied in three-unit ceramic fixed dental prostheses. The absolute marginal discrepancy of three-unit ceramic fixed dental prostheses fabricated using digital technology was comparable to that of conventional technique.

Effect of different preparation finishing procedures on the marginal and internal fit of CAD-CAM-produced restorations: A microcomputed tomography evaluation

STATEMENT OF PROBLEM

Accurate fit is an important factor for the longevity of computer-aided design and computer-aided manufacturing (CAD-CAM) ceramic restorations. Few studies have compared how restoration finishing procedures affect the marginal and internal fit of these restorations by using microcomputed tomography (μCT).

PURPOSE

The purpose of this in vitro study was to evaluate the preparations with different surface finishing procedures for the fit of CAD-CAM restorations by using μCT.

MATERIAL AND METHODS

A total of 28 anatomic contour monolithic feldspathic ceramic crowns were produced for 4 typodont teeth prepared according to the different surface finishing procedures (n=7). The generated experimental groups were finishing with extra-coarse (181 μm) diamond rotary instruments (EC), finishing with fine (40 μm) diamond rotary instruments after extra-coarse diamond rotary instruments (F), finishing with very fine (20 μm) diamond rotary instruments after extra-coarse and fine diamond rotary instruments (VF), and finishing with extra-coarse, fine, and very fine diamond rotary instruments followed by polishing rubber points (P). μCT scans were obtained to measure the gaps between the typodont teeth and the crowns. Reference points such as the margin, chamfer (the deepest point), cusp tips, and central fossa were determined, and 196 measurements were made. Data were analyzed by using 2-way analyses of variance and the Tukey HSD test (α=.05).

RESULTS

The highest gap values in all sections were observed in the finishing with extra-coarse (181 μm) diamond rotary instruments group. The lowest gap value in the marginal point was observed in the P group (P<.05). In total, the gap values of the reference points were in the order of margin, chamfer, cusp, and central fossa.

CONCLUSIONS

μCT evaluation showed that tooth preparation finishing procedure with finer grit rotary instruments yielded better marginal fit for monolithic feldspathic CAD-CAM restorations. The internal gap values of all groups were also in the range of clinically acceptable values, important for mechanical properties.

Digital evaluation of the effect of nanosilica-lithium spray coating on the internal and marginal fit of high translucent zirconia crowns

OBJECTIVES

To evaluate the effect of a nanosilica-lithium spray coating on the internal and marginal fit of high translucent zirconia crowns using a digital evaluation method.

METHODS

A three-dimensional analysis model of a zirconia abutment was digitally scanned using a dental scanner, and 30 monolithic high translucent zirconia crowns were designed and fabricated. They were divided into groups (n = 10) according to the surface treatment method: (1) no treatment: as-sintered zirconia; (2) airborne-particle abrasion with 50 μm Al₂O₃ particles; and (3) nanosilica-lithium spray coating. Three-dimensional data for the abutment, crown, and crown seated on the abutment were obtained using a dental scanner. The three-dimensional seated fit between the crown and abutment was reconstructed using registration technology, and a three-dimensional (3D) deviation analysis was used to evaluate the effect of different modification methods on the internal and marginal fit of the crowns using root mean square (RMS) values.

RESULTS

The 3D deviation analysis of all groups conformed to a normal distribution (P > 0.05), and the variance was homogeneous (P > 0.05). The different surface treatments had no significant effect on the RMS values in the occlusal, axial, and marginal regions of the high translucent zirconia crowns (P > 0.05).

CONCLUSIONS

Nanosilica-lithium spray coating for the modification of as-sintered zirconia is clinically feasible and does not affect the internal or marginal fit of high translucent zirconia crowns.

CLINICAL SIGNIFICANCE

Nanosilica-lithium spray coating does not affect the adaptation of zirconia crowns and is a clinically feasible surface treatment method for zirconia. It is unnecessary to add the setting values of the internal and marginal fit when fabricating nanosilica-lithium-sprayed zirconia crowns.

Comparison of Short-Term Restorative Effects and Periodontal Health Status of Restorations Made of Different Materials in Full-Crown Restoration of Mandibular Premolar Tooth Defects

Purpose

To compare the short-term restorative effect and periodontal health status of restorations with different materials in full-crown restoration of mandibular premolar tooth defects.

Methods

A total of 105 cases (123 affected teeth) of mandibular premolar tooth defects who visited the Department of Stomatology between January 2019 and January 2020 were selected, of which 58 cases (68 affected teeth) restored with cobalt-chromium alloy porcelain crowns were included in the metal-ceramic crown (MCC) group and 47 cases (55 affected teeth) repaired by zirconium dioxide all-ceramic crowns were assigned to the zirconia crown (ZC) group. The restorative effect, inflammatory factors (high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α)) and periodontal health indicators (human cartilage glycoprotein-39 (YKL-40), resistin, aspartate aminotransferase (AST), and alkaline phosphatase (ALP)) after treatment, and the occurrence of adverse reactions were compared between the two groups.

Results

The ZC group outperformed the MCC group in terms of margin fitness, restoration fracture, gingival condition, and color matching. After restoration, hs-CRP and TNF-α were statistically decreased in both groups, while YKL-40, resistin, AST, and ALP were significantly increased; and compared with the MCC group, hs-CRP, TNF-α, YKL-40, resistin, AST, and ALP were lower in the ZC group. The ZC group also scored statistically higher in retention effect, aesthetic effect, masticatory function, voice function, and comfort. Moreover, the ZC group had a higher total effective rate and a lower incidence of adverse reactions than the MCC group, with statistical significance.

Conclusions

Zirconia dioxide all-ceramic crowns contribute to a better short-term restorative effect in the full-crown restoration of mandibular premolar tooth defects, with little impact on periodontal health and high patient satisfaction, which deserves popularization and application.

Effect of different finish line preparations on the marginal and internal adaptation of cobalt-chromium metal alloy copings fabricated by using CAD-CAM technology: A systematic review and meta-analysis

STATEMENT OF PROBLEM

The marginal and internal adaptation of a fixed dental prosthesis depends on a variety of factors, finish line designs being one of them. A clear consensus as to which finish line design can provide a better marginal and internal adaptation with respect to cobalt-chromium metal alloy copings fabricated by using computer-aided design and computer-aided manufacturing (CAD-CAM) technology is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effect of different finish line preparations on the marginal and internal adaptation of cobalt-chromium metal alloy copings fabricated by using CAD-CAM technology.

MATERIAL AND METHODS

Electronic (PubMed, Cochrane, EBSCOhost, and Google Scholar) and manual searches were conducted for articles published from January 2010 to December 2020 to identify relevant studies evaluating the effect of different finish line preparations (chamfer, deep chamfer, shoulder, rounded shoulder) on the marginal and internal adaptation of cobalt-chromium metal alloy copings fabricated by using CAD-CAM technology.

RESULTS

A total of 573 articles were obtained via electronic search, and 10 articles were obtained through manual search, of which 24 in vitro studies were selected after title, abstract, and full-text screening and were included for both qualitative and quantitative analyses. The marginal adaptation was evaluated under the parameters of marginal gap, absolute marginal discrepancy, and vertical marginal discrepancy, whereas internal adaptation was evaluated under the parameters of internal gap, cervical discrepancy, axial discrepancy, and occlusal discrepancy. The methods of CAD-CAM fabrication (direct metal laser sintering, hard milling, and soft milling) were considered under the subgroup analysis.

CONCLUSIONS

An overall better marginal and internal adaptation was observed with shoulder and rounded shoulder finish line designs when CAD-CAM methods were used for coping fabrication. Marginal and internal adaptation in chamfer and deep chamfer finish line designs showed better results with soft milling and direct metal laser sintering methods, whereas shoulder finish line showed better results with hard milling.

Comparison of marginal and internal fit of three-unit implant-supported fixed prosthetic substructures fabricated using CAD/CAM systems

OBJECTIVE

This study compared the marginal and internal fit of implant-supported fixed dentures fabricated using CAD/CAM systems.

MATERIALS AND METHODS

A lower jaw model representing partial edentulism was produced. Two dental implants were inserted in the area of teeth 35 and 37, onto which cemented abutments were screwed. The model was scanned using a laboratory scanner and transferred to a design software program for substructure fabrication. Sixty substructures were fabricated out of each group for six substructure types (n = 10), cast Co-Cr (control), milling Co-Cr, laser sintering Co-Cr, titanium (Ti), zirconium, and polyetheretherketone (PEEK) substructures. The marginal and internal fit was evaluated using a silicone replica viewed under a stereomicroscope. The data were analyzed using the statistical package program for social sciences (SPSS, Chicago, IL, USA, v. 17) at a significance level of 0.05. Marginal and internal gaps were compared using the one-way ANOVA test and Tukey's post hoc test. The differences between abutment teeth were determined using the independent sample t-test.

RESULTS

There was a significant difference in the marginal gap between PEEK and Ti groups (p < 0.05) but no difference between other groups (p > 0.05). There was a significant difference in the internal gap between PEEK, laser sintering Co-Cr, and milling Co-Cr groups (p < 0.05) but no difference between other groups (p > 0.05). The PEEK group had a higher marginal gap than the Ti group and a higher internal gap than the DMLS Co-Cr group (p < 0.05).

CONCLUSION

All substructures have a marginal and internal fit within acceptable clinical limits.

CLINICAL RELEVANCE

This in vitro study suggests that materials and techniques used in CAD/CAM systems improve the fitting accuracy of implant-supported fixed restorations.

Assessment of internal fit and micro leakage of conventionally fabricated ceramometallic restoration versus CAD wax and press veneering (in-vitro study)

Statement of problem

Accuracy of internal fit and microleakage for CAD-CAM systems used in metal coping fabrication and veneered with layering or pressing porcelain in ceramometallic restoration is unclear.

Material and methods

A master metal die was milled to resemble the right mandibular first molar preparation for coverage with ceramometallic restoration. Master die was duplicated to twenty-four resin specimen dies.They were divided into two groups according to metal coping construction technique using either conventional (C) or CAD (D) wax. Each group was subdivided into two subgroups (n = 6) according to the technique of porcelain veneering (layered or pressed) to fabricate ceramometallic restorations, where subgroup (CL, DL) were conventionally layered by porcelain and (CP, DP) were press veneered. A standardized thickness of metal and porcelain was performed in all specimens as per manufacturer’s instructions for techniques ceramometallic restoration construction.

Evaluation of internal fit was done with silicone replica technique using stereomicroscope at ×24 magnification where the thickness of silicon layer was measured at 20 reference points on each specimen. Then specimens were subjected to thermocycling. Sectioned specimens were assessed for microleakage using a stereomicroscope at ×12 magnification along die-cement interface with a five scale score.

Results

Mean internal gap values of veneering showed a statistically nonsignificant difference between specimens made with layering(L) and pressing(P). Different techniques of wax construction showed a non-significant difference in internal gap values between specimens made with conventional(C) and CAD(D) waxing. However, a significant difference was found in the internal gap at different sites. The highest internal gap was found at the occlusal surface, while the lowest gap was found at the finish line. The highest mean microleakage score was found with CAD wax and press veneering, while the lowest mean microleakage score was found with conventional wax and press veneering.

Conclusion

Both construction techniques of ceramometallic restoration were considered reliable in restoration production within a clinically acceptable range regarding internal fit and microleakage. There is a strong positive correlation between internal fit and microleakage of ceramometallic restoration constructed.

Effect of virtual cement gap settings on the marginal fit of cemented resin-ceramic crowns on implant abutments

STATEMENT OF PROBLEM

Agreement on the perfect virtual cement space value for computer-aided design and computer-aided manufacturing (CAD-CAM) implant-supported resin-ceramic crowns with the best marginal adaptation is lacking. The range of cement gap settings in some CAD design software programs is wide (0 to 200 μm), and manufacturer recommendations regarding the best cement gap setting for certain types of ceramics is not specific.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of virtual cement gap settings on the marginal fit of cemented resin-ceramic crowns on implant abutments.

MATERIAL AND METHODS

Thirty implant analogs and matching stock abutments were coupled and implanted into autopolymerizing acrylic resin blocks. Three groups (n=10) of resin-ceramic molar crowns with 3 different virtual cement space settings (40, 60, and 100 μm) were designed by using a CAD design software program. The crowns were cemented over their corresponding abutments under a static load by using a specially designed cementing device. A scanning electron microscope was used to measure the mean vertical marginal gap (MG) for each group, where a total of 120 measurements for each of the 3 groups (12 sites per crown and 10 crowns per group) were evaluated. One-way analysis of variance and the post hoc Tukey pairwise comparison tests were used to analyze the data (α=.05).

RESULTS

A significant difference (P<.001) was found between the MG values of the resin-ceramic implant-supported crowns fabricated by using the 3 cement space settings. The smallest MG was obtained with the 60-μm setting as compared with the 40-μm and 100-μm settings.

CONCLUSIONS

A limited inverse relation was found between the MGs of CAD-CAM-fabricated resin-ceramic implant-supported crowns and the cement gap settings in the exocad software program. The smallest MGs were obtained when a 60-μm cement space value was used (P<.001).

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.

In vitro validation of Digital Image Analysis Sequence (DIAS) for the assessment of the marginal fit of cement-retained implant-supported experimental crowns

BACKGROUND

The replica technique with its modifications (negative replica) has been used for the assessment of marginal fit (MF). However, identification of the boundaries between prosthesis, cement, and abutment is challenging. The recently developed Digital Image Analysis Sequence (DIAS) addresses this limitation. Although DIAS is applicable, its reliability has not yet been proven. The purpose of this study was to verify the DIAS as an acceptable method for the quantitative assessment of MF at cemented crowns, by conducting statistical tests of agreement between different examiners.

METHODS

One hundred fifty-one implant-supported experimental crowns were cemented. Equal negative replicas were produced from the assemblies. Each replica was sectioned in six parts, which were photographed under an optical microscope. From the 906 standardized digital photomicrographs (0.65 μm/pixel), 130 were randomly selected for analysis. DIAS included tracing the profile of the crown and the abutment and marking the margin definition points before cementation. Next, the traced and marked outlines were superimposed on each digital image, highlighting the components' boundaries and enabling MF measurements. One researcher ran the analysis twice and three others once, independently. Five groups of 130 measurements were formed. Intra- and interobserver reliability was evaluated with intraclass correlation coefficient (ICC). Agreement was estimated with the standard error of measurement (SEM), the smallest detectable change at the 95% confidence level (SDC_95%), and the Bland and Altman method of limits of agreement (LoA).

RESULTS

Measured MF ranged between 22.83 and 286.58 pixels. Both the intra- and interobserver reliability were excellent, ICC = 1 at 95% confidence level. The intra- and interobserver SEM and SDC_95% were less than 1 and 3 pixels, respectively. The Bland-Altman analysis presented graphically high level of agreement between the mean measurement of the first observer and each of the three other observers' measurements. Differences between observers were normally distributed. In all three cases, the mean difference was less than 1 pixel and within ± 3 pixels LoA laid at least 95% of differences. T tests of the differences did not reveal any fixed bias (P > .05, not significant).

CONCLUSION

The DIAS is an objective and reliable method able to detect and quantify MF at ranges observed in clinical practice.

Casting over Metal Method Used in Manufacturing Hybrid Cobalt-Chromium Dental Prosthetic Frameworks Assembles

Cobalt–chromium (Co–Cr) alloys are the most widely used materials for removable and fixed dental prosthetic frameworks. The fitting accuracy between these components in dental prosthetic frameworks assembles (DPFAs) is largely influenced by the manufacturing method. This study presents a novel manufacturing method that combined two common techniques for obtaining one single framework: casting of Co–Cr inserts on top of parts previously manufactured by selective laser melting (SLM) of Co–Cr powder (CoM). Horizontal (n = 4) and vertical (n = 3) surfaces were microscopically analyzed (n = 770 count sum). The results revealed a high precision of the process and high fitting accuracy between the hybrid frameworks. The average distance measured between the frameworks in joined position was 41.08 ± 7.56 µm. In conclusion, the manufacturing of Co–Cr alloys DPFA using the CoM method reduced the deformation of hybrid frameworks and improved the joining accuracy between them.

Comparison of microstructures and mechanical properties of 3 cobalt-chromium alloys fabricated with soft metal milling technology

STATEMENT OF PROBLEM

Although several manufacturers market soft metal milling blanks and systems, comprehensive comparative studies of differences in properties across commercially available soft metal milling alloys are lacking.

PURPOSE

The purpose of this in vitro study was to compare the microstructures and mechanical properties of 3 soft metal milling cobalt-chromium (Co-Cr) alloys (Ceramill Sintron, Soft Metal, and Sintermetall).

MATERIAL AND METHODS

Disk-shaped specimens (for surface characterization and hardness test) and dumbbell-shaped specimens (for tensile test as per International Organization for Standardization (ISO) 22674) were prepared by following each soft metal milling manufacturer's instructions. The crystal structures and microstructures of the 3 alloys were evaluated with optical microscopy, X-ray diffractometry (XRD), and scanning electron microscopy with electron backscattered diffraction (EBSD). The mechanical properties were investigated with a tensile test and Vickers hardness test (n=6). The results of the mechanical (tensile and hardness) tests were analyzed with 1-way ANOVA and the post hoc Tukey multiple comparison test (α=.05).

RESULTS

The Sintermetall specimen showed a finer microstructure and more porosity than the other 2 alloys. The XRD and EBSD analyses showed that the γ (face-centered cubic, fcc) matrix phase was predominant in the Ceramill Sintron alloy and the ε (hexagonal close-packed, hcp) matrix phase was predominant in the Soft Metal alloy. The Sintermetall alloy showed a slightly higher amount of ε phase than γ phase, with more chromium carbide formation than the other 2 alloys. The Ceramill Sintron alloy showed a significantly higher tensile strength than the other 2 alloys (P<.05), but a significantly lower 2% offset yield strength than the other 2 alloys (P<.05). The highest elongation was found in the Ceramill Sintron alloy, followed by the Sintermetall and Soft Metal alloys. The elastic modulus was the highest in the Sintermetall alloy, followed by the Soft Metal and Ceramill Sintron alloys. No significant differences in Vickers hardness values were detected among the 3 alloys (P=.263).

CONCLUSIONS

The different commercially available soft metal milling blanks and systems produced dissimilar alloys in terms of crystal structures and microstructures and, as a result, different mechanical properties.

Oriented face-centered cubic to hexagonal close-packed martensitic transition, grain morphology, and mechanical properties of Co-Cr alloy fabricated by selective laser melting

STATEMENT OF PROBLEM

Removable partial dentures (RPDs) can be fabricated by selective laser melting (SLM) with different build orientations. How microstructures and mechanical properties of SLM Co-Cr alloy are affected by different build orientations is unclear.

PURPOSE

The purpose of this in vitro study was to investigate the phase structures, grain morphology, and mechanical properties of SLM Co-Cr alloy with different build orientations.

MATERIAL AND METHODS

SLM Co-Cr tensile specimens were fabricated at orientation angles of 0, 45, and 90 degrees between the building and longitudinal direction named the T0, T45, and T90 design groups (n=14). Mechanical properties were obtained by tensile testing conducted by using a universal testing machine according to the International Organization for Standardization (ISO) 22674. The grains along the longitudinal direction of the specimens and phase structures were observed before and after tensile testing by electron backscatter diffraction. One-way analysis of variance followed by the Bonferroni post hoc test and Kruskal-Wallis test were used for statistical analysis (α=.05).

RESULTS

The 0.2% yield strengths in descending order were T90 (870 MPa)>T45 (840 MPa)>T0 (786 MPa) (P<.05); the elongations were T0 (21.8%)>T45 (15.6%)>T90 (8.7%) (P<.05); the ultimate tensile strengths were T45 (1226 MPa)>T90 (1200 MPa)>T0 (1149 MPa) (P<.05). The average grain sizes in the T0, T45, and T90 groups were 22 μm, 18 μm, and 14 μm, respectively. After the tensile test, a face-centered cubic (FCC) to hexagonal close-packed (HCP) martensitic transition was found in each group, and the phase transition area fractions were T0 (38.3%)>T45 (11.4%)>T90 (0.7%).

CONCLUSIONS

The FCC to HCP martensitic transition, grain morphology, and mechanical properties of SLM Co-Cr alloy depended on the build orientations. The oriented phase transition and grains affected the anisotropic mechanical properties of SLM Co-Cr alloy.

Effect of Anti-Rotational Abutment Features and Novel Computerized Fabrication Techniques on the Marginal Fit of Implant-Supported Metal Copings

PURPOSE

An in vitro study to compare the marginal fit of cobalt-chromium (Co-Cr) metal copings fabricated with selective laser melting (SLM), computer-aided design and computer-aided manufacturing (CAD/CAM) milling, and lost-wax (LW) techniques, on abutments with two different antirotational features.

MATERIALS AND METHODS

A total of 60 stainless steel abutments with the same length and convergence angles were fabricated using a numerical control machining. Half of the abutments had one flat plane, while the other half had three grooves as an antirotation feature. Thirty abutments of each kind were then divided into three subgroups, and metal copings were fabricated with SLM, CAD/CAM milling, or the LW technique (n = 10). The metal copings were cemented with polycarboxylate cement. Marginal gap measurements were performed using a stereomicroscope at a magnification of × 45 and data were analyzed with two-way analysis of variance (ANOVA) tests.

RESULTS

The LW (p = 0.002) and CAD/CAM (p < 0.001) techniques exhibited increased marginal gaps on the abutments with a three groove antirotational feature; however, no significant difference was detected with the SLM technique (p = 0.259). The copings fabricated with the SLM technique demonstrated significantly lower gap values in both abutment types (p < 0.001).

CONCLUSION

While all marginal gap values were within the clinically acceptable range (<120 µm), abutments with more antirotational grooves exhibited wider marginal gaps with the LW and CAD/CAM techniques.

Evaluation of marginal discrepancy in metal frameworks fabricated by sintering-based computer-aided manufacturing methods

PURPOSE

The aim of this in vitro study was to evaluate the effect of sintering procedures on marginal discrepancies of fixed partial metal frameworks fabricated using different sintering-based computer-aided design and computer/aided manufacturing (CAD/CAM) techniques.

MATERIALS AND METHODS

Forty resin die models of prepared premolar and molar abutment teeth were fabricated using a three-dimensional (3D) printer and divided into four groups (n = 10) according to the fabrication method of metal frameworks used: HM (via hard milling), SM (via soft metal milling), L25 (via direct metal laser melting [DMLM] with a 25 µm layer thickness), and L50 (via direct DMLM with a 50 µm layer thickness). After the metal frameworks were fabricated and cemented, five vertical marginal discrepancy measurements were recorded in each site (i.e., buccal, facing the pontic, lingual, and facing away from the pontic) of both abutment teeth under a stereomicroscope (×40). Data were statistically analyzed at a significance level of 0.05.

RESULTS

No statistically significant differences (P>.05) were found among the four axial sites of metal frameworks fabricated by sintering-based CAD/CAM techniques. The HM and L25 groups showed significantly (P<.001) lower marginal discrepancy values than the SM and L50 groups.

CONCLUSION

Marginal discrepancy in the sites facing the pontic was not influenced by the type of sintering procedure. All fabrication methods exhibited clinically acceptable results in terms of marginal discrepancies.

Effect of porcelain firing and cementation on the marginal fit of implant-supported metal-ceramic restorations fabricated by additive or subtractive manufacturing methods

STATEMENT OF PROBLEM

Adaptation between abutment and suprastructure plays a crucial role in the long-term success of implant-supported metal-ceramic crowns. Fabrication methods, the porcelain firing stage, and cementation techniques may affect the marginal adaptation between the crown and abutment. However, the information regarding this issue is sparse.

PURPOSE

The purpose of this in vitro study was to compare marginal fit after the fabrication of cobalt-chromium alloy copings, porcelain firing, and cementation of metal-ceramic restorations that were fabricated with computer-aided design and computer-aided manufacturing (CAD-CAM) milling and direct metal laser sintering techniques.

MATERIAL AND METHODS

Thirty straight tissue-level titanium abutments were screwed onto implant analogs. All specimens were embedded in acrylic resin and divided into 2 groups according to CAD-CAM milling and direct metal laser sintering fabrication of the metal coping. Fifteen cobalt-chromium implant-supported metal copings were fabricated by using the CAD-CAM milling technique and 15 by using the direct metal laser sintering technique. In both groups, marginal gap measurements between the cobalt-chromium copings and abutments were obtained before (T0) and after the placement of the ceramic veneer (T1) and after cementation (T2) by using a stereomicroscope with a magnification of ×40. The data were statistically evaluated by using 2-way ANOVA and the Tukey post hoc test (α=.05). A t test was used to determine whether there were significant differences between the fabrication techniques (α=.05).

RESULTS

A significant difference in the fabrication stages was found in the direct metal laser sintering group. The direct metal laser sintering coping group and porcelain applied direct metal laser sintering group had a statistically lower marginal gap value than the cemented direct metal laser sintering group (P=.021, P=.038). The direct metal laser sintering coping group had a lower marginal gap value than the CAD-CAM milling coping group, although the difference was not statistically significant (P=.216).

CONCLUSIONS

Porcelain firing and cementation increased the marginal gap between the crown and abutment. No statistically significant differences were found between the direct metal laser sintering and CAD-CAM milling techniques in terms of marginal fit.

Zirconia-ceramic versus metal-ceramic posterior multiunit tooth-supported fixed dental prostheses: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The authors aimed to compare the survival and complication rates of zirconia-ceramic (ZC) versus metal-ceramic (MC) restorative material in multiunit tooth-supported posterior fixed dental prostheses (FDP).

TYPES OF STUDIES REVIEWED

The authors conducted a systematic search of randomized controlled trials (RCTs), with no time or language restrictions, up to May 2019 using the MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases, followed by a manual search.

RESULTS

The authors included 7 RCTs in the review and 5 RCTs in the meta-analysis. All studies had a low risk of bias. The authors included 330 participants (177 ZC and 173 MC tooth-supported FDP) in the meta-analysis, which revealed a medium-term survival rate of 95.4% (95% confidence interval [CI], 90.5% to 99.1%) for ZC FDP compared with 96.9% (95% CI, 94.3% to 99.4%) for MC FDP, with no significant differences (P = .364). The biological or technical complications did not show statistically significant differences, except in the global ceramic veneering chipping analysis (P = .023; risk difference [RD], 22.3%; 95% CI, 3.0% to 41.6%) and their subanalysis: minor chipping or chipping that can be solved with polishing (P = .044; RD, 19.5%; 95% CI, 0.5% to 38.4%), and major chipping or chipping that needs repair in the laboratory (P = .023; RD, 6.0%; 95% CI, 0.8% to 11.3%).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Posterior multiunit ZC restorations are considered a predictable treatment in the medium term, although they are slightly more susceptible to chipping of the veneering ceramic than MC restorations.

Dimensional Changes of Yttria-stabilized Zirconia under Different Preparation Designs and Sintering Protocols

PURPOSE

To evaluate the linear and volumetric dimensional changes that occur throughout the fabrication process of monolithic 4.5-6% yttria-stabilized zirconia copings under the influence of different preparation designs and two sintering protocols.

MATERIALS AND METHODS

A titanium master die was fabricated using Atlantis core file implant-abutment. Six copings were designed virtually according to different finish line offsets and coping thicknesses, with four equidistant occlusal posts for linear measurements. Zirconia copings were milled using IPS e.max ZirCAD LT zirconia blanks. The experimental groups according to the coping designs were the following: G1: 0.5 mm finish line offset, 0.5 mm thickness; G2: 0.5 mm finish line offset, 1.0 mm thickness; G3: 0.5 mm finish line offset, 1.5 mm thickness; G4: 1.2 mm finish line offset, 0.5 mm thickness; G5: 1.2 mm finish line offset, 1.0 mm thickness; G6: 1.2 mm finish line offset, 1.5 mm thickness. Six samples per group were sintered by standard sintering (SS) and the other six by fast sintering (FS). Linear and volumetric measurements were taken at the three fabrication stages (virtual design, milling stage, and sintering) by using an intraoral scanner and imported as the .stl file to Meshmixer software for analysis. Statistical analysis was performed by a linear mixed effect model via statistical software R (R Core team, 2018).

RESULTS

There was a significant interaction between the coping design group, stage of fabrication and sintering protocol on the linear (F = 4.451, p < 0.001) and volumetric (F = 2.716; p < 0.001) dimensional changes. Standard sintering G1 showed the smallest linear and dimensional changes among the groups compared to the reference design. Sintered copings had shrunk on average 1.32% within SS and 1.54% within FS linearly and 3.82% within SS and 3.90% within FS volumetrically compared to the initial design parameters.

CONCLUSION

The linear and volumetric dimensional changes did not differ significantly between standard and fast sintering protocols, and the preparation designs had more influence on the dimensional changes compared to sintering protocols.

Digital evaluation of laser scanning speed effects on the intaglio surface adaptation of laser-sintered metal frameworks

STATEMENT OF PROBLEM

Laser sintering has several processing parameters, typically under the control of dental laboratory technicians. Laser scan speed is an important parameter, which has a significant effect on manufacturing time but may also affect the adaptation of restorations. However, limited information is available regarding its impact.

PURPOSE

The purpose of this in vitro study was to evaluate the intaglio surface adaptation of laser-sintered cobalt-chromium single-crown frameworks sintered at laser scanning speeds of 1, 3, and 6 m/s.

MATERIAL AND METHODS

A master bronze metal die was prepared and scanned by using a laboratory scanner to fabricate the metal frameworks for 4 groups (n=10). In group C, the frameworks were fabricated by using the lost-wax method (control). In group L1, L3, and L6, the frameworks were fabricated by using direct metal laser melting (DMLM) at laser scanning speeds of 1, 3, and 6 m/s. After fabrication, 3 scanning data sets were used to evaluate the intaglio surface adaptation: the master die, the intaglio surface of each metal framework, and each metal framework seated on the master die. The intaglio surface adaptation of the metal frameworks was evaluated by using a metrology software program. The data were statistically analyzed by using a 1-way ANOVA, the Tukey honestly significant difference test, and the Tamhane T2 test (α=.05).

RESULTS

The highest mean intaglio surface discrepancy value was obtained from group L6, and this was significantly different from the other 3 groups (P<.001). No significant intaglio surface discrepancy differences were found among the other groups.

CONCLUSION

The amount of intaglio surface discrepancy increased when the laser scanning speed reached 6 m/s.

Marginal Discrepancy of Single Implant-Supported Metal Copings Fabricated by Various CAD/CAM and Conventional Techniques Using Different Materials

Objective  Framework patterns can be formed using various materials such as wax, acrylic resin, or composite. Frameworks can be fabricated using either conventional or computerized techniques, using additive or subtractive method. This study aimed to compare the marginal adaptation of metal copings fabricated by two computerized technologies (milling and rapid prototyping) and additive conventional methods using different materials.

Materials and Methods  Seventy-two fixture analogs were mounted vertically in acrylic resin. One-piece abutments with 5.5 mm in length and 6 degrees of convergence were secured into the analogs. The experimental frameworks were fabricated using either subtractive CAD/CAM milling (by wax, soft or hard metal), additive rapid prototyping (by wax), or conventional pattern fabrication (by wax [control] or acrylic resin). Wax and acrylic resin patterns were casted in Ni-Cr alloy. Marginal discrepancy was measured in 12 points by video measuring machine.

Statistical Analysis  One-way ANOVA and posthoc tests were used to detect any significant difference among the groups at α= 0.05.

Results  There was a statistically significant difference among the marginal discrepancy of six groups ( p = 0.018). The Tukey test indicated a significant difference between CAD/milling of soft metal and conventional wax pattern groups ( p = 0.011); a significant difference was also reported between CAD/milling of wax patterns and control group ( p = 0.046).

Conclusions  Frameworks fabricated by conventional wax-up showed the largest marginal gaps, while the marginal gap created by frameworks made of soft metal CAD/milling were the smallest. In addition, frameworks fabricated by rapid prototyping showed clinically acceptable adaptations.

Influence of ceramic firing on marginal gap accuracy and metal-ceramic bond strength of 3D-printed Co-Cr frameworks

STATEMENT OF PROBLEM

The marginal gap and ceramic bond strength of metal-ceramic restorations are important for success. However, studies evaluating the marginal gap and ceramic bond strength of fixed partial dentures (FPDs) produced with 3D printing technologies such as selective laser melting (SLM) are scarce.

PURPOSE

The purpose of this in vitro study was to investigate the marginal gap of cobalt-chromium (Co-Cr) alloy frameworks produced by SLM technology before and after ceramic firing. Additionally, the metal-ceramic bond strength was evaluated with the Schwickerath crack-initiation test according to the International Standards Organization (ISO) 9693-1:2012.

MATERIAL AND METHODS

Conventional impressions were made, and the definitive cast of a patient requiring a 4-unit FPD was scanned. After designing the FPD, the files were sent to a service center for the fabrication of a metal master model, 80 Co-Cr frameworks, and 80 flat specimens (25×3×0.5 mm) with SLM technology. The marginal gap between frameworks and the abutment tooth of the metal master model was nondestructively measured by using an optical coordinate-measuring machine. A total of 80 sets, consisting of 1 framework and 1 flat specimen, were sent to 80 dental laboratory technicians for ceramic firing. Detailed instructions for correct manipulation of the framework and flat specimen were provided. The marginal gap was remeasured, and the 3-point bend test was used to evaluate metal-ceramic bond strength.

RESULTS

Only 28 of the 80 dental technicians returned the specimens within a prespecified time and/or in adequate condition. The mean ±standard deviation marginal gap of the framework before ceramic firing was 25 ±9 μm and 34 ±12 μm after firing. The difference was statistically significant (P=.001). The mean ±standard deviation 3-point bend strength was 33 ±9 MPa.

CONCLUSIONS

Ceramic firing affected the marginal gap; however, all Co-Cr frameworks had a marginal gap lower than 120 μm, which is reported to be a clinically acceptable limit. Most of the specimens (80%) had a metal-ceramic bond strength value higher than the 25-MPa ISO 9693 requirement. Five of 28 dental laboratory technicians were not able to comply with ceramic firing instructions.

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.

Evaluation of dimensional accuracy of dental bridges manufactured with conventional casting technique and CAD/CAM system with Ceramill Sintron blocks using CMM

Background. Recently, non-presintered chromium-cobalt (Cr-Co) blocks with the commercial name of Ceramill Sintron were introduced to the market. However, comprehensive studies on the dimensional accuracy and fit of multi-unit frameworks made of these blocks using the coordinate measuring machine (CMM) are lacking. This study aimed to assess and compare the dimensional changes and fit of conventional casting and milled frameworks using Ceramill Sintron.

Methods. A metal model was designed and scanned and 5-unit frameworks were fabricated using two techniques: (I) the conventional casting method (n=20): the wax model was designed, milled in the CAD/CAM machine, flasked and invested; (II) the milling method using Ceramill Sintron blocks (n=20): the wax patterns of group 1 were used; Ceramill Sintron blocks were milled and sintered. Measurements were made on the original reference model and the fabricated frameworks using the CMM in all the three spatial dimensions, and dimensional changes were recorded in a checklist. Data were analyzed with descriptive statistics, and the two groups were compared using one-way ANOVA and Tukey test (α=0.05).

Results. The fabricated frameworks in both groups showed significant dimensional changes in all the three dimensions. Comparison of dimensional changes between the two groups revealed no significant differences (P>0.05) except for transverse changes (arch) that were significantly greater in Ceramill Sintron frameworks (P<0.05).

Conclusion. The two manufacturing processes were the same regarding dimensional changes and the magnitude of marginal gaps and both processes resulted in significant dimensional changes in frameworks. Ceramill Sintron frameworks showed significantly greater transverse changes than the conventional frameworks.

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.

Effect of layer thickness on the marginal and internal adaptation of laser-sintered metal frameworks

STATEMENT OF PROBLEM

Laser sintering is commonly used for fabricating metal-ceramic restorations. The layer thickness of the sintering process may affect restoration adaptation. However, limited information is available regarding its impact.

PURPOSE

The purpose of this in vitro study was to compare the marginal and internal adaptation of laser-sintered cobalt-chromium single crown frameworks sintered with layer thicknesses of 25 and 50 μm.

MATERIAL AND METHODS

Thirty resin dies that represented prepared single molar abutment teeth were prepared by using a 3-dimensional printer and were divided into 3 groups (n=10) according to the method used for fabricating metal frameworks: group C, metal frameworks fabricated by using the lost-wax method (control); group L25, metal frameworks fabricated by using direct metal laser melting with a layer thickness of 25 μm; and group L50, metal frameworks fabricated by using direct metal laser melting with a layer thickness of 50 μm. After fabricating the metal frameworks, 15 vertical marginal discrepancy measurements were made in each axial region (mesial, distal, buccal, and lingual) using a stereomicroscope. Next, all the specimens were sectioned from the midline, and 5 internal discrepancy measurements were made in each internal region (inner marginal, axial, and occlusal). The data were analyzed statistically by using 1-way ANOVA, the Tukey honestly significant difference, and Tamhane T2 tests (α=.05).

RESULTS

The highest marginal and internal discrepancy values were obtained for metal frameworks in group C, and these values were significantly different (P<.001) from those obtained for metal frameworks in the other 2 groups. No significant difference was observed in the marginal and internal discrepancy values of metal frameworks in groups L25 and L50.

CONCLUSIONS

These results indicate that layer thickness does not affect the adaptation of laser-sintered metal frameworks, yet both sintering parameters yielded significantly lower mean marginal discrepancy values than the cast group.

Effect of Different Post-Sintering Temperatures on the Microstructures and Mechanical Properties of a Pre-Sintered Co–Cr Alloy

Although a cobalt–chromium (Co–Cr) blank in a pre-sintered state has been developed, there are few data on the optimal temperature for the alloy in terms of the desired mechanical properties. A metal block (Soft Metal, LHK, Chilgok, Korea) was milled to produce either disc-shaped or dumbbell-shaped specimens. All the milled specimens were post-sintered in a furnace at 1250, 1350 or 1450 °C. The microstructures, shrinkage and density of the three different alloys were investigated using the disc-shaped specimens. The mechanical properties were investigated with a tensile test according to ISO 22674 (n = 6). The number and size of the pores in the alloys decreased with increased temperature. The shrinkage and density of the alloys increased with temperature. In the 1250 °C alloy, the formation of the ε (hexagonal close-packed) phase was more predominant than that of the γ (face-centered cubic) phase. The 1350 °C and 1450 °C alloys showed γ phase formation more predominantly. Carbide formation was increased along with temperature. The 1450 °C group showed the largest grain size among the three groups. In general, the 1350 °C group exhibited mechanical properties superior to the 1250 °C and 1450 °C groups. These findings suggest that 1350 °C was the most optimal post-sintering temperature for the pre-sintered blank.

Comparative Study of the Fit Accuracy of Full-Arch Bar Frameworks Fabricated with Different Presintered Cobalt-Chromium Alloys

Purpose

This study was to measure the geometric discrepancies that occur during the sintering contraction of presintered Co-Cr alloys in a full-arch bar framework and to compare the variations between alloys from different manufacturers.

Materials and Methods

Eighteen implant-supported full-arch bar frameworks were fabricated through a soft-machining process using presintered Co-Cr alloy blocks: Ceramill Sintron (CS), Soft Metal (SM), and Sintermetall (SML) (n=6 for each group). The sintered frameworks were digitized using a structured light scanner, and the scan images were superimposed on the reference design. The geometric discrepancies of the sintered frameworks were three-dimensionally analyzed for horizontal, angular, and internal discrepancies. Kruskal-Wallis and Mann-Whitney U tests were used to compare the discrepancies among the groups (α=.05).

Results

Significant differences were found in the geometric discrepancy measurements among the groups. The CS group showed larger horizontal and angular discrepancies, followed by the SM and SML groups (P<.001). The root mean square (RMS) values for internal discrepancy were not statistically different among the groups (P=.778).

Conclusion

The geometric discrepancies of full-arch bar frameworks fabricated using the soft-machining process were affected by accuracies in sintering contraction of presintered alloys.

Evaluation of early resin luting cement damage induced by voids around a circular fiber post in a root canal treated premolar by integrating micro-CT, finite element analysis and fatigue testing

OBJECTIVE

This study utilizes micro-CT image combined with finite element (FE) analysis and in vitro fatigue testing to investigate the mechanical behavior associating with early resin luting cement damage induced by voids around a circular fiber post in a root canal treated premolar.

METHODS

Six similar mandibular first premolars with root canal treatment were scanned with high resolution micro-CT before and after fatigue testing. Micro-CT images of all teeth were processed to identify various materials (dentin, luting cement and void) to evaluate the volume/position of the void in each reconstructed tooth root canal model. Six corresponding mesh models from CT images were generated to perform FE simulations under receiving oblique concentrated loads (200N) to evaluate the luting cement layer mechanical behavior. All teeth were subjected to the fatigue test with 240,000 load cycles simulating chewing for one year to compare results with those in FE simulations.

RESULTS

The result showed that most voids occurred adjacent to the apical third of the fiber post. Voids induced the fiber post to pull out, creating a stress concentration at the void boundary. Fatigue life in the experimental testing was found decreased with the stress value/micro-motion increasing in FE analysis.

SIGNIFICANCE

This study establishes that micro-CT, FE simulation and fatigue testing can be integrated to understand the early de-bonding mechanism at the luting cement layer in a root canal treated premolar, suggesting that attention must be paid to resin luting cement dissolving/debonding easier when voids occur in the apical and peri-apical areas of fiber posts.

Precision of the milled full-arch framework fabricated using pre-sintered soft alloy: A pilot study

PURPOSE

This study aimed to evaluate the marginal discrepancy of full-arch frameworks in implant-supported prostheses fabricated using pre-sintered soft alloy (PSA).

MATERIALS AND METHODS

Full-arch metal frameworks were fabricated on the edentulous implant model using casting alloy (CA), fully-sintered hard alloy (FHA), and PSA (n = 4 in each group). To evaluate the misfit of the framework to the abutments, the absolute marginal discrepancy (AMD) values of the frameworks were measured in cross-sectional images that had been drawn as part of the triple-scan protocol. The AMD values were compared among the tested alloy groups using the Kruskal-Wallis test, with a post hoc Mann-Whitney U test (α=.05).

RESULTS

The FHA and PSA groups showed lower marginal discrepancies than the CA group (P<.001). However, the FHA group did not differ significantly from the PSA group.

CONCLUSION

Soft alloy milling is comparable to hard alloy milling, and it is more precise than casting in terms of the marginal fit of implant-supported, full-arch prostheses.

Mechanical properties of cobalt-chromium 3-unit fixed dental prostheses fabricated by casting, milling, and additive manufacturing

STATEMENT OF PROBLEM

New additive manufacturing techniques for nonprecious alloys have made the fabrication of metal-ceramic fixed partial dentures (FPDs) less expensive and less time-consuming. However, whether the mechanical properties produced by these techniques are comparable is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the mechanical properties of cobalt-chromium frameworks for FPDs fabricated by 3 different techniques.

MATERIAL AND METHODS

Thirty frameworks for 3-unit FPDs were fabricated by traditional casting, computer-aided design and computer-aided manufacturing (CAD-CAM) milling, and selective laser melting (SLM), with n=10 in each group. The frameworks were weighed, and distal and mesial connector areas measured. The frameworks were cemented and loaded centrally (0.5 mm/s) until deformation above 1 mm occurred. Stiffness was measured as the slope of the axis between 500 and 2000 N. Microhardness was measured on sectioned specimens by Vickers indentation. The microstructure was also analyzed by scanning electron microscopy. One-way ANOVA with Tukey post hoc analysis was used to compare the groups (α=.05).

RESULTS

The framework design differed among the groups, making a comparison of strength impossible. The milled frameworks appeared bulky, while the cast and SLM frameworks were more slender. Statistically significant differences were found in microhardness, stiffness, wall thickness, weight, and connector size (P<.05), and a significant correlation was found between hardness and stiffness (-0.4, P<.005).

CONCLUSIONS

Fabrication method affects the design, stiffness, microhardness, and microstructure of cobalt-chromium FPD frameworks. The SLM frameworks were stiffer and harder than the cast and milled specimens.

Cobalt-chromium alloys in fixed prosthodontics in Sweden

Aim: The aim of this study was to compile the usage of Co-Cr alloys in fixed prosthodontics (FP) among dental laboratories in Sweden.

Methods: From March to October 2015, questionnaires were sent to 542 registered dental laboratories in Sweden. The questionnaires were divided in two parts, one for fixed dental-supported prosthodontics (FDP) and one for fixed implant-supported prosthodontics (FIP). Reminders were sent three times.

Results: In total of 542 dental laboratories, 55% answered the questionnaires. Most dental laboratories use Co-Cr in FP, 134 (74%) in FDP and 89(66%) in FIP. The laboratories used Co-Cr alloys of various compositions in the prostheses, 35 for FDP and 30 for FIP. The most commonly used Co-Cr alloys for tooth-supported FDPs were (a) Wirobond^® 280, (b) Cara SLM and (c) Wirobond^® C. For implant-supported frameworks the frequently used alloys were: (a) Cara SLM, (b) Cara Milled and (c) Wirobond^® 280. Except for the difference in composition of these alloys, they were also manufactured with various techniques. In tooth-supported prostheses the dominating technique was the cast technique while newer techniques as laser-sintering and milling were more commonly reported for implant-supported constructions. A fourth technique; the ‘pre-state’ milling was reported in FDP.

Conclusion: More than 30 different Co-Cr alloys were reported as being used in FP. Thus, there is a need for studies exploring the mechanical and physical behavior and the biological response to the most commonly used Co-Cr alloys.

Development of an expert system for the simulation model for casting metal substructure of a metal-ceramic crown design

BACKGROUND AND OBJECTIVES

Nowadays, the integrated CAD/CAE systems are favored solutions for the design of simulation models for casting metal substructures of metal-ceramic crowns. The worldwide authors have used different approaches to solve the problems using an expert system. Despite substantial research progress in the design of experts systems for the simulation model design and manufacturing have insufficiently considered the specifics of casting in dentistry, especially the need for further CAD, RE, CAE for the estimation of casting parameters and the control of the casting machine. The novel expert system performs the following: CAD modeling of the simulation model for casting, fast modeling of gate design, CAD eligibility and cast ability check of the model, estimation and running of the program code for the casting machine, as well as manufacturing time reduction of the metal substructure.

METHODS

The authors propose an integration method using common data model approach, blackboard architecture, rule-based reasoning and iterative redesign method. Arithmetic mean roughness values was determinated with constant Gauss low-pass filter (cut-off length of 2.5mm) according to ISO 4287 using Mahr MARSURF PS1. Dimensional deviation between the designed model and manufactured cast was determined using the coordinate measuring machine Zeiss Contura G2 and GOM Inspect software.

RESULTS

The ES allows for obtaining the castings derived roughness grade number N7. The dimensional deviation between the simulation model of the metal substructure and the manufactured cast is 0.018mm. The arithmetic mean roughness values measured on the casting substructure are from 1.935µm to 2.778µm.

CONCLUSIONS

The realized developed expert system with the integrated database is fully applicable for the observed hardware and software. Values of the arithmetic mean roughness and dimensional deviation indicate that casting substructures are surface quality, which is more than enough and useful for direct porcelain veneering. The manufacture of the substructure shows that the proposed ES allows the improvement of the design process while reducing the manufacturing time.

Evaluation of marginal fit of single implant-supported metal-ceramic crowns prepared by using presintered metal blocks

STATEMENT OF PROBLEM

Recently, presintered metal blocks for nonprecious and precious metal implant-supported restorations have gained popularity in computer-aided design and computer-aided manufacturing (CAD-CAM) systems. However, few studies have evaluated the marginal discrepancy of implant-supported restorations made with these new alloy systems.

PURPOSE

The purpose of this in vitro study was to compare the milling-sintering method with the lost-wax and milling methods in terms of the marginal fit of implant-supported metal-ceramic restorations.

MATERIAL AND METHODS

Thirty implant abutments screwed to implant analogs were embedded into acrylic resin to investigate marginal fit and then divided according to fabrication methods into the following 3 groups (n=10): lost-wax (LW; control group), milling (M), and milling-sintering (MS). Porcelain material was applied to all specimens after completion of the fabrication process. Subsequently, all specimens were cemented to implant abutments for the measurement of marginal discrepancies. Twelve marginal discrepancy measurements were recorded on each implant abutment by using a stereomicroscope. The arithmetic mean of these 12 measurements was considered the mean marginal discrepancy value of each abutment. Data were statistically analyzed by using 1-way ANOVA and Tukey honest significant difference tests (α=.05).

RESULTS

The lowest mean marginal discrepancy values (81 ±2 μm) were observed in the M group, which was significantly different (P<.001) from the other methods. The highest mean marginal discrepancy values (99 ±2 μm) were observed in the MS group.

CONCLUSIONS

The results revealed that restorations prepared by the milling-sintering method provided clinically acceptable results (<120 μm); however, this new technique was not found to be as precise as the milling method in terms of marginal fit.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

Veneering increased the marginal gap width of copings.

CLINICAL RELEVANCE

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