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Riera C, Karasan D, Sailer I, Mojon P, Fehmer V, Pitta J. Mechanical stability of posterior implant-supported monolithic zirconia cantilever on titanium-base abutments. An in vitro study. Clin Oral Implants Res 2024; 35:1042-1053. [PMID: 38415804 DOI: 10.1111/clr.14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Investigate survival and technical complications of two-unit posterior implant-supported cantilever made of monolithic zirconia on titanium-base abutments (Zr-TiB) vs. porcelain-fused-to-metal on castable gold abutments (PFM-GA) using two different implant connections, internal butt-joint (IBJ) and internal conical (IC). MATERIALS AND METHODS Forty-eight implants (4.3 mm diameter) were divided into four groups (n = 12) to support 2-unit mandibular premolar cantilevers with two different materials (Zr-TiB vs. PFM-GA) and two connection types (IBJ vs. IC). Tested groups were as follows: (1) IBJ/Zr-TiB; (2) IBJ/PFM-GA; (3) IC/Zr-TiB; and (4) IC/PFM-GA. Specimens were thermomechanical aged (1,200,000 cycles, 98 N, 5-55°C) with occlusal axial load on the pontic. Catastrophic and non-catastrophic events were registered, and removal torque values measured before and after aging. Specimens surviving aging were subjected to loading until failure. Survival, total complication rates, torque loss (%), and bending moments were calculated. RESULTS From 48 specimens, 38 survived aging. Survival rates significantly varied from 16.7% (IC/PFM-GA) to 100% (IBJ/Zr-TiB; IBJ/PFM-GA; IC/Zr-TiB) (p < .01). Internal conical connection revealed significantly higher torque loss (IC/ZrTiB - 67%) compared to internal butt-joint (IBJ/Zr-TiB - 44%; IBJ/PFM-GA - 46%) (p < .01). Bending moments were higher in internal butt-joint connections than in internal conical (p < .05). CONCLUSION AND CLINICAL IMPLICATIONS Two-unit posterior implant-supported cantilever FDPs replacing mandibular premolars composed of monolithic zirconia on titanium-base abutments demonstrated higher mechanical stability compared to porcelain-fused-to-metal on castable gold abutments in this in vitro study. The internal conical connection combined with porcelain-fused-to-metal on gold abutments revealed a high number of failures; therefore, their clinical use may be considered cautiously for this indication.
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Affiliation(s)
- Carme Riera
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Phillipe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - João Pitta
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
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Garcia E, Tung TW, Jaramillo S, Gutierrez A, Alvear J, Tinajero M. Full-Arch Rehabilitation With Mucosa-Supported Prostheses Utilizing a Digital Workflow: A Case Report. Cureus 2024; 16:e64941. [PMID: 39035587 PMCID: PMC11259404 DOI: 10.7759/cureus.64941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 07/23/2024] Open
Abstract
The advent of digital workflows has revolutionized oral rehabilitation, offering excellent prosthesis and restoration adaptation while reducing work time. This case report aims to describe a full-arch rehabilitation protocol using mucosa-supported prostheses through a digital workflow. The technique begins with scanning the upper jaw and taking an impression of the lower jaw, followed by scanning to create a digital cast. Next, border molding and the final impression of both arches are performed using a closed-mouth technique, during which the patient is guided to perform lateral and protrusive movements. Subsequently, intraoral scanning of the occlusion and both impressions is conducted, leading to the design of the final dentures with the established occlusion. Finally, the dentures are printed in Formlabs resin specifically designed for dentures. The digital workflow facilitates the manufacturing of mucosa-supported full-arch prostheses effectively. This method allows for the adjustment of the vertical dimension of occlusion, ensures excellent adaptation of the prosthesis to the soft tissues, and provides aesthetic satisfaction for the patient. Additionally, it reduces the number of sessions required to install the definitive prosthesis.
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Affiliation(s)
- Edgar Garcia
- Prosthodontics, Universidad de Especialidades Espiritu Santo, Guayaquil, ECU
| | - Ting Wei Tung
- Prosthodontics, University of Specialties Holy Spirit, Guayaquil, ECU
| | | | | | | | - Maurício Tinajero
- Periodontology, Universidad de Especialidades Espiritu Santo, Guayaquil, ECU
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Jurado CA, Sayed Ahmed A, Lawson NC, Azpiazu-Flores FX, Green C, Cho SH. Fracture resistance of zirconia surveyed crowns with four different occlusal rest seat designs. J Prosthodont 2024; 33:484-489. [PMID: 37471621 DOI: 10.1111/jopr.13737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To determine the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD-CAM) zirconia surveyed crowns for a mandibular first molar without occlusal rest and with four different rest seat designs. MATERIALS AND METHODS Seventy CAD-CAM zirconia 4Y-PSZ (IPS e.max ZirCAD MT for CEREC A1, C15, Ivoclar Vivadent) crowns (14 specimens/group) were designed and fabricated with a dental chairside CAD-CAM system (CEREC PrimeScan, and CEREC MCXL Dentsply Sirona). The restorations were divided into groups according to the following rest seat designs: (1) Surveyed crown without rest seat, (2) surveyed crowns with disto-occlusal rest seat, (3) surveyed crowns with disto-occlusal extended rest seat, (4) surveyed crowns with interproximal rest seat, and (5) continuous rest seat. Crowns were treated with a primer system (Monobond Plus, Ivoclar Vivadent) and cemented using resin luting cement (Multilink Automix, Ivoclar Vivadent) to resin-printed dies (Grey Resin V4, FormLabs). Subsequently, the crowns were subjected to 200,000 load cycles at 1 Hz with 20 N force and then loaded with a steel indenter until fracture. The test results were analyzed with one-way Analysis of Variance (ANOVA) and HSD Tukey post-Hoc test. RESULTS The mean fracture resistance of surveyed crowns without and with different rest seats was significantly different from each other. Surveyed crowns with no rest seat displayed the highest resistance (4238 N) followed by crowns with continuous rest seat (3601 N), crowns with disto-occlusal extended rest seat (3283 N), and crowns with disto-occlusal rest seat (3257 N). Crowns with interproximal rest seat displayed the lowest fracture resistance (2723 N). CONCLUSIONS Surveyed crowns without rest seats had a higher fracture resistance than crowns with rest seats Surveyed crowns with interproximal rest seats presented the lowest fracture resistance among all rest seat designs. Crowns with disto-occlusal rest seats, disto-occlusal extended rest seats, and continuous rest seats displayed similar fracture resistance.
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Affiliation(s)
- Carlos Alberto Jurado
- Department of Prosthodontics, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
| | - Akram Sayed Ahmed
- Department of Dental Biomaterials, Tanta University Faculty of Dentistry, Tanta, Egypt
| | - Nathaniel C Lawson
- Division of Biomaterials, Department of Clinical and Community Sciences, University of Alabama at Birmingham School of Dentistry, Birmingham, Alabama, USA
| | - Francisco X Azpiazu-Flores
- Department of Restorative Dentistry, University of Manitoba Gerald Niznick College of Dentistry, Winnipeg, Manitoba, Canada
| | - Conley Green
- Texas Tech University Health Sciences Center El Paso Woody L. Hunt School of Dental Medicine, El Paso, Texas, USA
| | - Seok-Hwan Cho
- Department of Prosthodontics, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
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Abuhammoud S, Emtier B, Fu CC, Rojas-Rueda S, Jurado CA, Afrashtehfar KI. Fracture resistance of CAD/CAM milled versus direct hand-made interim laminate veneers. Saudi Dent J 2024; 36:920-925. [PMID: 38883892 PMCID: PMC11178957 DOI: 10.1016/j.sdentj.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 06/18/2024] Open
Abstract
Background Comparative studies of interim veneer restorations crafted using subtractive computer-aided manufacturing (s-CAM) milling technology and traditional direct hand-made approaches are needed. Purpose This comparative in vitro study evaluated the fracture resistance of two types of provisional veneer restorations for maxillary central incisors: milled (s-CAM) and traditional direct hand-made bis-acryl veneers. Materials and methods Fifty maxillary right central incisor veneers (25 specimens per group) were fabricated and divided according to the fabrication method: (1) s-CAM milled (Structure CAD, VOCO Dental); and (2) hand-made (Protemp Plus, 3M). The restorations were cemented onto 3D-printed resin dies using temporary cement and subjected to 1000 cycles of thermal cycling between 5° and 55 °C. These restorations subsequently were subjected to compressive loading until fracture occurred. Images of the fractured samples were captured using a scanning electron microscope (SEM). Statistical analysis was performed using the one-way ANOVA test and the Mann-Whitney U test. Results Significant differences (p < 0.001) in the fracture resistance were observed between the two groups. s-CAM milled interim veneers displayed higher fracture resistance values (439.60 ± 26 N) compared to the traditional method (149.15 ± 10 N). Conclusion The manufacturing method significantly influences the fracture resistance of interim veneer restorations. s-CAM interim laminate veneer restorations for maxillary central incisors exhibit a fracture resistance superior to that of the traditional method using bis-acryl.Clinical relevanceClinicians should consider CAD/CAM milled veneers for scenarios demanding long-term interim restoration and the withstanding of high occlusal forces.
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Affiliation(s)
- Salahaldeen Abuhammoud
- Department of Prosthodontics, University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Banan Emtier
- University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, USA
| | - Chin-Chuan Fu
- Department of Restorative Sciences, University of Alabama at Birmingham School of Dentistry, Birmingham, AL, USA
| | - Silvia Rojas-Rueda
- Division of Biomaterials, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama Birmingham, Birmingham, AL, USA
- School of Dentistry, Pontifical Javerian University, Bogota, Colombia
| | - Carlos A Jurado
- Division of Operative Dentistry, Department of General Dentistry, University of Tennesse Health Science Center College of Dentistry, Memphis, TN, USA
| | - Kelvin I Afrashtehfar
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Berne, BE, Switzerland
- Clinical Sciences Department, College of Dentistry, Ajman University, Ajman City, Emirate of Ajman, United Arab Emirates
- Private Practice Limited to Prosthodontics, Dubai, DU, United Arab Emirates
- Private Practice Limited to Prosthodontics, Abu Dhabi City, AZ, United Arab Emirates
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany
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Daher R, Ardu S, di Bella E, Krejci I, Duc O. Efficiency of 3D printed composite resin restorations compared with subtractive materials: Evaluation of fatigue behavior, cost, and time of production. J Prosthet Dent 2024; 131:943-950. [PMID: 36333176 DOI: 10.1016/j.prosdent.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022]
Abstract
STATEMENT OF PROBLEM Three-dimensionally (3D)-printed composite resins have been marketed as materials for definitive restorations. However, limited information is available regarding the stability of the adhesive interface and the efficiency of 3D printed composite resins. PURPOSE The purpose of this in vitro study was to evaluate the integrity of the marginal adhesive interface before and after thermal and mechanical fatigue of an initial formulation of a 3D printed composite resin and to evaluate the efficiency of this manufacturing method. MATERIAL AND METHODS Freshly extracted molars were prepared for onlays and adhesively restored with either 3D printed composite resin (VarseoSmile Crown Plus) (Group 3D), milled composite resin (Tetric CAD) (Group MCOMP), milled PMMA (Telio CAD) (Group PMMA), and milled lithium disilicate (IPS e.max CAD) (Group EM). Marginal analysis was performed under a scanning electron microscope before and after fatigue by thermomechanical cyclic loading, and initial and terminal percentages of continuous margin (%CM) were compared. The time required for the production of each type of restoration was recorded, and the production costs were also compared. RESULTS Before aging, 3D, MCOMP, and EM presented comparable values of %CM (69.8%, 75.9%, and 63.1%, respectively) that were statistically significantly higher (P<.05) than those of PMMA (45.1%). After aging, 3D and EM had comparable results (44.7% and 43.7%, respectively), which were lower than those of the MCOMP group (68.5%) but higher than those of the PMMA group (20.5%). Regarding time efficiency, 3D printing took less time than MCOMP or PMMA if more than 8 restorations were fabricated. For the production costs, 3D printing was 5.5, 8.7, and 10.2 times less expensive than PMMA, MCOMP, and EM, respectively. The initial equipment cost was also lower for the additive manufacturing method. However, 3D printing did not always considerably reduce waste. CONCLUSIONS In terms of marginal adaptation, the evaluated initial formulation of a 3D printed composite resin behaved similarly to other well-established definitive restoration materials and better than milled PMMA, both before and after fatigue. Three-dimensionally printed resins present advantages in terms of equipment and consumable costs, even for a single restoration, but also for production time when more than 8 restorations were fabricated.
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Affiliation(s)
- René Daher
- Lecturer, Division of Cariology and Endodontology, Clinique Universitaire de Médecine Dentaire (CUMD), University of Geneva, Geneva, Switzerland.
| | - Stefano Ardu
- Senior Lecturer, Treatment Plan Unit and Division of Cariology and Endodontology, Clinique Universitaire de Médecine Dentaire (CUMD), University of Geneva, Geneva, Switzerland
| | - Enrico di Bella
- Assistant Professor, Department of Political Science, University of Genoa, Genoa, Italy
| | - Ivo Krejci
- Full Professor and Chairman, Division of Cariology and Endodontology, Clinique Universitaire de Médecine Dentaire (CUMD), University of Geneva, Geneva, Switzerland
| | - Olivier Duc
- Senior Lecturer, Division of Cariology and Endodontology, Clinique Universitaire de Médecine Dentaire (CUMD), University of Geneva, Geneva, Switzerland
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Huang HY, Yang YT, Chuang CC, Shen YK, Chen MH, Lin WC. Evaluation of the clinical application of personalized 3D printing and CAD/CAM resin crowns to replace stainless steel crowns in paediatric dentistry. Int J Paediatr Dent 2024. [PMID: 38570933 DOI: 10.1111/ipd.13182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/23/2023] [Accepted: 01/04/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Children with dental caries are treated with stainless steel metal crowns (SSC), but the aesthetics and precision still need to be improved. Currently, both 3D-printed resin crowns (PRC) and computer-aided design/computer-aided manufacture (CAD/CAM) resin crowns (CRC) meet the clinical requirements for crown applications in terms of strength, production time, cost, and aesthetics. AIM This study replaced SSC with customized resin crowns by 3D printing and CAD/CAM. DESIGN In this study, PRC, CRC, and SSC were used for incisor and molar restorations, and 60 crowns were made with 10 for each group. The fabrication efficiency, surface characteristics, marginal fit, and stability of the two different crowns were evaluated. RESULTS PRC and CRC show superior color and surface characteristics, though production times are longer (5.3-12.4 times and 3.3-9.1 times, respectively) than for SSC (p < .05). They, however, can be completed within 80 min. Edge gaps for PRC and CRC are significantly lower (13.0-19.2 times and 13.0-13.7 times) than for SSC (p < .05). All materials exhibit good stability. CONCLUSION The 3D-PRCs and CAD/CAM resin crowns may replace SSCs as a potential choice for clinical child caries.
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Affiliation(s)
- Huei-Yu Huang
- Department of Pediatric Dentistry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Ya-Ting Yang
- Department of Pediatric Dentistry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chun-Chao Chuang
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
- Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yung-Kang Shen
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Mu-Hsiung Chen
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Chun Lin
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Center for Tooth Bank and Dental Stem Cell Technology, Taipei Medical University, Taipei, Taiwan
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Tabata LF, Hilgert LA, Pereira ALC, Ribeiro APD, Pereira PNR. Microshear bond strength of resin cement to glass-ceramics after intaglio surface staining. J Prosthet Dent 2024; 131:314-319. [PMID: 35300848 DOI: 10.1016/j.prosdent.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
STATEMENT OF PROBLEM Applying stains to the intaglio surface of computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic ceramic restorations has been proposed as an option to help mask darkened substrates. However, little is known about the effects of this procedure on the adhesion between the resin cement and the ceramic. PURPOSE The purpose of this in vitro study was to evaluate the effect of intaglio surface staining on the microshear bond strength between 2 CAD-CAM ceramics and a resin cement. MATERIAL AND METHODS Lithium disilicate (Gmax) and leucite-reinforced (Gpress) ceramic blocks were sectioned, crystalized when indicated, and polished. They received either none, 1, or 2 layers of ceramic stains and a glaze liquid mixture followed by a firing cycle. The surfaces of groups Gmax0, Gmax1, and Gmax2 were etched with 9% hydrofluoric acid etching (HF) for 20 seconds, and those of groups Gpress0 and Gpress1 were etched for 60 seconds. After rinsing and drying, a ceramic primer was applied and air-dried. Resin cement rods (n=24 per group) were built from a silicone mold. Specimens were stored in distilled water for 24 hours before microshear bond testing. Failure mode was observed under a digital microscope. Data were analyzed by using the Kruskal-Wallis and Mann-Whitney nonparametric tests (α=.05). RESULTS Intaglio staining negatively affected the microshear bond strength for both ceramics. A significant difference was observed between Gmax1 (3.5 ±1.73 MPa) and Gmax2 (3.7 ±2.1 MPa) when compared with Gmax0 (14.2 ±4.4 MPa) and also between GPress0 (25.7 ±5.1 MPa) and Gpress1 (1.8 ±2.7 MPa). No difference was observed between 1 and 2 stain layers for Gmax. Most failures were adhesive for Gmax0, mixed for Gpress, and cohesive within the stain layer for experimental groups. CONCLUSIONS Intaglio surface staining with a stain and glaze mixture caused a significant reduction in bond strength between resin cement and both ceramics tested.
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Affiliation(s)
- Lucas F Tabata
- Professor, Dentistry Department, School of Health Sciences, University of Brasilia (UnB), Brasilia, Distrito Federal, Brazil.
| | - Leandro A Hilgert
- Professor, Dentistry Department, School of Health Sciences, University of Brasilia (UnB), Brasilia, Distrito Federal, Brazil
| | | | - Ana Paula D Ribeiro
- Professor, Operative Dentistry Department, College of Dentistry, University of Florida, Gainesville, Fla
| | - Patrícia N R Pereira
- Professor, Operative Dentistry Department, College of Dentistry, University of Florida, Gainesville, Fla
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Mangano FG, Cianci D, Pranno N, Lerner H, Zarone F, Admakin O. Trueness, precision, time-efficiency and cost analysis of chairside additive and subtractive versus lab-based workflows for manufacturing single crowns: An in vitro study. J Dent 2024; 141:104792. [PMID: 38013004 DOI: 10.1016/j.jdent.2023.104792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To evaluate the trueness, precision, time efficiency, and cost of three different workflows for manufacturing single crowns (SCs). METHODS A plaster model with a prepared tooth (#15) was scanned with an industrial scanner, and an SC was designed in computer-assisted-design (CAD) software. Ten SCs were printed with a hybrid composite (additive chairside) and a stereolithographic (SLA) printer (Dfab®), 10 SCs were milled in lithium disilicate (subtractive chairside) using a chairside milling unit (inLab MC XL®), and 10 SCs were milled in zirconia (lab-based) using a five-axis laboratory machine (DWX-52D®). All SCs were scanned with the same scanner after polymerization/sinterization. Each scan was superimposed to the marginal area of the original CAD file to evaluate trueness: absolute average (ABS AVG), root mean square (RMS), and (90˚-10˚)/2 percentile were calculated for each group. Marginal adaptation and quality of the occlusal and interproximal contact points were also investigated by two prosthodontists on 3D printed and plaster models. Finally, the three workflows' time efficiency and costs were evaluated. RESULTS Additive chairside and subtractive lab-based SCs had significantly better marginal trueness than subtractive chairside SCs in all three parameters (ABS AVG, p < 0.01; RMS, p < 0.01; [90˚-10˚]/2, p < 0.01). However, the two prosthodontists found no significant differences between the three manufacturing procedures in the quality of the marginal closure (p = 0.186), interproximal (p = 0.319), and occlusal contacts (p = 0.218). Both time efficiency and cost show a trend favoring the chairside additive workflow. CONCLUSIONS Chairside additive technology seems to represent a valid alternative for manufacturing definitive SCs, given the high marginal trueness, precision, workflow efficiency and low costs. STATEMENT OF CLINICAL RELEVANCE Additive chairside manufacturing of definitive hybrid composite SCs is now possible and shows high accuracy, time efficiency, and competitive cost.
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Affiliation(s)
- Francesco Guido Mangano
- Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
| | | | - Nicola Pranno
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Henriette Lerner
- Department of Oral, Maxillofacial and Plastic Surgery, Goethe University, Frankfurt, Germany
| | - Fernando Zarone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Oleg Admakin
- Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia
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Liu CM, Lin WC, Lee SY. Evaluation of the efficiency, trueness, and clinical application of novel artificial intelligence design for dental crown prostheses. Dent Mater 2024; 40:19-27. [PMID: 37858418 DOI: 10.1016/j.dental.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/05/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE The unique structure of human teeth limits dental repair to custom-made solutions. The production process requires a lot of time and manpower. At present, artificial intelligence (AI) has begun to be used in the medical field and improve efficiency. This study attempted to design a variety of dental restorations using AI and evaluate their clinical applicability. METHODS Using inlay and crown restoration types commonly used in dental standard models, we compared differences in artificial wax-up carving (wax-up), artificial digital designs (digital) and AI designs (AI). The AI system was designed using computer calculations, and the other two methods were designed by humans. Restorations were made by 3D printing resin material. Image evaluations were compared with cone beam computed tomography (CBCT) by calculating the root mean squared error. RESULTS Surface truth results showed that AI (68.4 µm) and digital-designed crowns (51.0 µm) had better reproducibility. Using AI for the crown reduced the time spent by 400% (compared to digital) and 900% (compared to wax-up). Optical microscopic and CBCT images showed that AI and digital designs had close margin gaps (p < 0.05). The margin gap of the crown showed that the wax-up group was 4.1 and 4.3 times greater than those of the AI and digital crowns, respectively. Therefore, the utilization of artificial intelligence can assist in the production of dental restorations, thereby enhancing both production efficiency and accuracy. SIGNIFICANCE It is expected that the development of AI can contribute to the reproducibility, efficiency, and goodness of fit of dental restorations.
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Affiliation(s)
- Che-Ming Liu
- Department of Dentistry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Wei-Chun Lin
- Department of Dentistry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; Center for Tooth Bank and Dental Stem Cell Technology, Taipei Medical University, Taipei 110, Taiwan; School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan.
| | - Sheng-Yang Lee
- Department of Dentistry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; Center for Tooth Bank and Dental Stem Cell Technology, Taipei Medical University, Taipei 110, Taiwan.
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Lu TY, Lin WC, Yang TH, Sahrir CD, Shen YK, Feng SW. The Influence of Dental Virtualization, Restoration Types, and Placement Angles on the Trueness and Contact Space in 3D-Printed Crowns: A Comprehensive Exploration. Dent J (Basel) 2023; 12:2. [PMID: 38275677 PMCID: PMC10814425 DOI: 10.3390/dj12010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
The current digital dentistry workflow has streamlined dental restoration production, but the effectiveness of digital virtual design and 3D printing for restorations still needs evaluation. This study explores the impact of model-free digital design and 3D-printing placement angles on restorations, including single crowns and long bridges produced with and without casts. The restorations are 3D printed using resin at placement angles of 0°, 60°, and 90°. Each group of samples was replicated ten times, resulting in a total of 120 restorations. The Root Mean Square Error (RMSE) value was used to evaluate the surface integrity of the restoration. In addition, the contact space, edge gap, and occlusal space of restorations produced by different processes were recorded. The results indicate that there was no significant difference in the RMSE value of the crown group (p > 0.05). Changing the bridge restoration angle from 0° to 90° resulted in RMSE values increasing by 2.02 times (without casts) and 2.39 times (with casts). Furthermore, the marginal gaps in the crown group were all less than 60 μm, indicating good adaptation. In contrast, the bridge group showed a significant increase in marginal gaps at higher placement angles (p > 0.05). Based on the findings, virtual fabrication without casts does not compromise the accuracy of dental restorations. When the position of the long bridge exceeds 60 degrees, the error will increase. Therefore, designs without casts and parallel placement result in higher accuracy for dental restorations.
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Affiliation(s)
- Tsung-Yueh Lu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Wei-Chun Lin
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Dentistry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Center for Tooth Bank and Dental Stem Cell Technology, Taipei Medical University, Taipei 110, Taiwan
| | - Tzu-Hsuan Yang
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Citra Dewi Sahrir
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yung-Kang Shen
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Sheng-Wei Feng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
- Division of Prosthodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei 110, Taiwan
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11
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Guo D, Mühlemann S, Pan S, Zhou Y, Jung RE. A double-blind randomized within-subject study to evaluate clinical applicability of four digital workflows for the fabrication of posterior single implant crown. Clin Oral Implants Res 2023; 34:1319-1329. [PMID: 37638493 DOI: 10.1111/clr.14171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To compare efficiency and clinical efficacy of posterior single implant crowns (PSIC) fabricated using four digital workflows. MATERIALS AND METHODS Twenty-two patients with one missing first molar were included. Each patient received four screw-retained implant crowns fabricated through four different workflows including a fully digital workflow with immediate digital impression (Group i-IOS), a fully digital workflow with digital impression after implant osseointegration (Group d-IOS), a model-based hybrid workflow using immediate analogue impression (Group i-AI), and a model-based hybrid workflow with conventional analogue impression after implant osseointegration (Group d-AI). The crown delivery sequence was randomized and blinded. The efficiency for each workflow and clinical outcome of each crown were recorded. RESULTS The average clinical working time in fully digital workflows (i-IOS 46.90 min, d-IOS 45.66 min) was significantly lower than that in the hybrid workflows (i-AI 54.59 min, d-AI 55.96 min; p < .001). Significantly more laboratory time was spent in hybrid workflows (i-AI 839.60 min, d-AI 811.73 min) as compared to fully digital workflows (i-IOS 606.25 min, d-IOS 607.83 min, p < .01). No significant differences in the chairside time at delivery were found. More crowns in Group i-AI (15%) needed additional laboratory interventions than in the other groups (p = .029). CONCLUSION Digital impression and model-free fully digital workflow improved prosthetic efficiency in the fabrication of PSIC. With the limitation that the results were only applicable to the implant system used and the digital technologies applied, findings suggested that workflows integrating immediate impression with implant surgery procedure was clinically applicable for restoration of PSIC.
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Affiliation(s)
- Danni Guo
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Shaoxia Pan
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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12
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Gagnon-Audet A, An H, Jensen UF, Bratos M, Sorensen JA. Trueness of 3-dimensionally printed complete arch implant analog casts. J Prosthet Dent 2023:S0022-3913(23)00421-3. [PMID: 37558526 DOI: 10.1016/j.prosdent.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023]
Abstract
STATEMENT OF PROBLEM Although a completely digital workflow has numerous advantages, a physical definitive cast may be especially helpful for the accurate assembly of components of complex complete arch-fixed prostheses, the evaluation of esthetic and occlusion features, or prosthesis fabrication. Research on the accuracy of additive complete arch casts with implants positioned with a large anterior-posterior (A-P) spread is sparse. PURPOSE The purpose of this in vitro study was to evaluate the trueness of complete arch 4-implant analog casts with a large A-P distribution fabricated with different 3-dimensional (3D) printers. MATERIAL AND METHODS Ten systems were evaluated representing currently available printing technologies and materials for the additive fabrication of complete arch 4-implant analog casts and compared for deviations in the X-, Y-, and Z-axes from the master model scan (MMS), recorded in standard tessellation language (STL). The MMS was provided to the laboratory selected by the manufacturer, permitting them to create their specific cast with computer-aided design and computer-aided manufacture specific to a particular system, including analog receptacle offset settings. Laboratories fabricated N=10 casts and affixed analogs. A conventional splinted impression and stone cast (CON) was fabricated as a control. The casts were scanned with a precision laboratory scanner (D2000; 3Shape A/S), and files were imported into the Convince metrology software program (3Shape A/S) for comparison with the MMS for mean deviations in the X-, Y-, and Z- axes. A 2-way ANOVA and the Tukey HSD comparison tests were performed between system groups and the 4 implant locations (α=.05). Comparative color maps were used to determine dimensional changes of the edentulous ridges. RESULTS For 2-dimensional deviations from the MMS in each of the 3 axes, the printer type, implant location, and interaction between those 2 variables were found to be statistically significant (P<.05). Comparisons among printers showed the smallest deviations for Asiga Pro 4K (ASG) and Stratasys Origin One (ORI) printers in both the X- and Y-axes and for CON in the Z-axis. For 3D deviations, comparison among printers indicated that ORI, SprintRay Pro55 S (SPR), and Ackuretta SOL (ACK) had the largest deviations, whereas CON and ASG showed the smallest deviations. Comparison color mapping demonstrates a disparity between printed model dimensional changes and implant analog positioning since the color maps of the casts' ridge crests were not in concordance with the results of the implant analog deviations. CONCLUSIONS ASG, 3D Systems ProJet MJP 2500 Plus (MJP), 3D Systems NextDent 5100 (NEX), Stratasys J5 DentaJet (PJ5), Ivoclar PrograPrint PR5 (PR5), and Prodways ProMaker LD20 (PWY) were similar in terms of 3D deviations to the conventional stone cast control. Comparative color mapping showed the direction and quantity of the dimensional changes of the ridge crest frequently did not correlate with the 3D deviations of implant analog positioning. Implant analog insertion errors were predominantly responsible for analog position 3D deviations rather than the polymerization shrinkage of additive photopolymers.
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Affiliation(s)
- Andréa Gagnon-Audet
- Graduate student, Graduate Prosthodontics Program, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash
| | - Hongseok An
- Assistant Professor, Department of Restorative Dentistry, School of Dentistry, Oregon Health and Science University, Portland, Ore
| | - Unnur Flemming Jensen
- Adjunct Professor, Department of Restorative Dentistry, School of Dentistry, University of Iceland, Reykjavik, Iceland; and Private practice, Reykjavik, Iceland
| | - Manuel Bratos
- Affiliate Lecturer, Department of Restorative Dentistry, and Associate, Biomimetics Biophotonics Biomechanics & Technology Laboratory, School of Dentistry, University of Washington, Seattle, Wash; and Private practice, Madrid, Spain
| | - John A Sorensen
- Professor, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; and Director, Biomimetics Biophotonics Biomechanics & Technology Laboratory, School of Dentistry, University of Washington, Seattle, Wash.
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13
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Lyu J, Yang X, Li Y, Tan J, Liu X. Dimensional accuracy and clinical adaptation of monolithic zirconia crowns fabricated with the nanoparticle jetting technique. J Prosthet Dent 2023:S0022-3913(23)00260-3. [PMID: 37217418 DOI: 10.1016/j.prosdent.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023]
Abstract
STATEMENT OF PROBLEM The nanoparticle jetting (NPJ) technique is a recently developed additive manufacturing method that may have useful dental applications. The manufacturing accuracy and clinical adaptation of zirconia monolithic crowns fabricated with NPJ are unknown. PURPOSE The purpose of this in vitro study was to compare the dimensional accuracy and clinical adaptation of zirconia crowns fabricated with NPJ and those fabricated with subtractive manufacturing (SM) and digital light processing (DLP). MATERIAL AND METHODS Five standardized typodont right mandibular first molars were prepared for ceramic complete crowns, and 30 zirconia monolithic crowns were fabricated using SM, DLP, and NPJ (n=10) with a completely digital workflow. The dimensional accuracy at the external, intaglio, and marginal areas was determined by superimposing the scanned data and computer-aided design data of the crowns (n=10). Occlusal, axial, and marginal adaptations were evaluated by using a nondestructive silicone replica and dual scanning method. The 3-dimensional discrepancy was evaluated to determine clinical adaptation. Differences among test groups were analyzed by using a MANOVA and the post hoc least significant difference test for normally distributed data or the Kruskal-Wallis test with Bonferroni correction for nonnormally distributed data (α=.05). RESULTS Significant differences were found in the dimensional accuracy and clinical adaptation among the groups (P<.001). The NPJ group had a lower overall root mean square (RMS) value for dimensional accuracy (22.9 ±1.4 μm) than the SM (27.3 ±5.0 μm) and DLP (36.4 ±5.9 μm) groups (P<.001). The NPJ group had a lower external RMS value (23.0 ±3.0 μm) than the SM group (28.9 ±5.4 μm) (P<.001) and equivalent marginal and intaglio RMS values than the SM group. The DLP group had larger external (33.3 ±4.3 μm), intaglio (36.1 ±10.7 μm), and marginal (79.4 ±12.9 μm) deviations than the NPJ and SM groups (P<.001). With regard to clinical adaptation, the marginal discrepancy was smaller in the NPJ group (63.9 ±27.3 μm) than in the SM group (70.8 ±27.5 μm) (P<.001). No significant differences were found between the SM and NPJ groups in terms of the occlusal (87.2 ±25.5 and 80.5 ±24.2 μm, respectively) and axial (39.1 ±19.7 and 38.4 ±13.7 μm, respectively) discrepancies. The DLP group had larger occlusal (239.0 ±60.1 μm), axial (84.9 ±29.1 μm), and marginal (140.4 ±84.3 μm) discrepancies than the NPJ and SM groups (P<.001). CONCLUSIONS Monolithic zirconia crowns fabricated using NPJ have higher dimensional accuracy and clinical adaptation than those fabricated using SM or DLP.
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Affiliation(s)
- Jizhe Lyu
- Graduate student, Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Xu Yang
- Clinical Associate Professor, Department Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yi Li
- Graduate student, Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jianguo Tan
- Professor, Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoqiang Liu
- Associate Professor, Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China.
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14
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Rauch A, Lorenz L, Reich S, Hahnel S, Schmutzler A, Schierz O. Long-term survival of monolithic tooth-supported lithium disilicate crowns fabricated using a chairside approach: 15-year results. Clin Oral Investig 2023:10.1007/s00784-023-05023-0. [PMID: 37083987 DOI: 10.1007/s00784-023-05023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES To investigate the clinical performance of chairside fabricated tooth-supported posterior single crowns from lithium disilicate ceramic. MATERIALS AND METHODS Thirty-four crowns (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein) were inserted between 2006 and 2007 and again evaluated after 15 years. Survival and success rates were calculated according to Kaplan-Meier, and the quality of the crowns was evaluated by using modified United States Public Health (USPHS) criteria. RESULTS Twenty-two crowns were available for recall; six patients were defined as dropouts. The mean observation period was 15.2 years (± 0.2). Six failures occurred (1 technical/5 biological) resulting in a survival rate of 80.1%. The success rate was 64.2%. The roughness of the crowns increased (p = 0.021) and the majority of adhesive gaps were discolored (p = 0.001) in comparison to baseline. The color, tooth, and crown integrity remained stable over the follow-up period (p ≥ 0.317). CONCLUSION The fabrication of tooth-supported lithium disilicate crowns using a chairside approach yielded acceptable long-term survival and success rates. Due to discoloration, the long-term use of dual-cure self-adhesive resin cements might result in unpleasing esthetic results. CLINICAL RELEVANCE The performance of posterior lithium disilicate single crowns revealed excellent to good clinical quality and an acceptable number of events after 15 years of clinical service.
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Affiliation(s)
- Angelika Rauch
- Department of Dental Prosthetics, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
- Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
| | - Lea Lorenz
- Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Sven Reich
- Department of Prosthodontics and Biomaterials, Centre of Implantology, Faculty of Medicine, RWTH University Hospital, Pauwellsstr. 30, 52074, Aachen, Germany
| | - Sebastian Hahnel
- Department of Dental Prosthetics, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Anne Schmutzler
- Department of Dental Prosthetics, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Oliver Schierz
- Department of Prosthodontics and Materials Science, University of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
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15
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Aswal GS, Rawat R, Dwivedi D, Prabhakar N, Kumar V. Clinical Outcomes of CAD/CAM (Lithium disilicate and Zirconia) Based and Conventional Full Crowns and Fixed Partial Dentures: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e37888. [PMID: 37213959 PMCID: PMC10199723 DOI: 10.7759/cureus.37888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/23/2023] Open
Abstract
Although CAD/CAM (computer-aided design/computer-aided manufacturing) restorations act as a favorable alternative to conventional metal-ceramic restorations for fixed dental prostheses, little is known about their intermediate and persistent clinical performance. This systematic review and meta-analysis aimed to assess the clinical performance in terms of biological, technical, and esthetic aspects and the survival and success ratios for single full crowns (SFCs) and fixed partial dentures (FPDs) fabricated by CAD/CAM and conventional techniques and according to the materials used (zirconia {ZC} and lithium disilicate {LD}). The population, intervention, control, outcome, and study design (PICOS) strategy was used to electronically search key terms in the PubMed, Cochrane Library, Embase, and Wiley Online databases for randomized control trials (RCTs) and cohort studies. The bias risks for RCTs and cohort studies were assessed using the Cochrane collaboration tool and the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using Rev5 from Cochrane. A total of 13 studies reporting on 1598 restorations in 1161 patients with a mean observation period of 3.6 years (minimum-maximum: 1-9.3 years) met the inclusion criteria. Meta-analysis of the included studies indicated that CAD/CAM manufacturing resulted in 1.17, 1.14, and 16.88 (95% CI: 0.64-2.17, 0.86-1.52, 7.59-37.56) higher biological, technical, and esthetic complications than conventional manufacturing of restorations. However, the difference was significant for esthetic complications only (p<0.00001). A significant difference was observed for all biological, technical, and aesthetic aspects between SFCs and FPDs (odds ratio {OR} = 2.61 vs. 1.78, 95% CI: 1.92-3.56 vs. 1.33-2.38; p<0.00001). The survival ratio of SFCs was 2.69 (95% CI: 1.98-3.65), significantly higher compared to the 1.76 (95% CI: 1.31-2.36) of FPDs (p<0.00001). The success ratio of FPDs at 1.18 (95% CI: 0.83-1.69) was significantly lower compared to SFCs at 2.36 (95% CI: 1.68-3.33). The clinical performance of LD with 2.42 (CI: 1.16-5.03) was significantly higher compared to ZC with 2.22 (CI: 1.78-2.77) (p<0.00001). The biological, technical, and aesthetic behaviors showed similar clinical outcomes between the CAD/CAM and conventional groups. LD could be a good alternative to zirconia, but its intermediate or persistent clinical performance needs to be evaluated. Overall, zirconia and CAD/CAM techniques must evolve further to outclass the conventional techniques used in the fabrication of SFCs and FPDs.
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Affiliation(s)
- Gunjan S Aswal
- Dentistry, The University of the West Indies, St. Augustine, TTO
| | - Renu Rawat
- Dentistry, The University of the West Indies, St. Augustine, TTO
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The Complete Digital Workflow in Fixed Prosthodontics Updated: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11050679. [PMID: 36900684 PMCID: PMC10001159 DOI: 10.3390/healthcare11050679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Digital applications have changed therapy in prosthodontics. In 2017, a systematic review reported on complete digital workflows for treatment with tooth-borne or implant-supported fixed dental prostheses (FDPs). Here, we aim to update this work and summarize the recent scientific literature reporting complete digital workflows and to deduce clinical recommendations. A systematic search of PubMed/Embase using PICO criteria was performed. English-language literature consistent with the original review published between 16 September 2016 and 31 October 2022 was considered. Of the 394 titles retrieved by the search, 42 abstracts were identified, and subsequently, 16 studies were included for data extraction. A total of 440 patients with 658 restorations were analyzed. Almost two-thirds of the studies focused on implant therapy. Time efficiency was the most often defined outcome (n = 12/75%), followed by precision (n = 11/69%) and patient satisfaction (n = 5/31%). Though the amount of clinical research on digital workflows has increased within recent years, the absolute number of published trials remains low, particularly for multi-unit restorations. Current clinical evidence supports the use of complete digital workflows in implant therapy with monolithic crowns in posterior sites. Digitally fabricated implant-supported crowns can be considered at least comparable to conventional and hybrid workflows in terms of time efficiency, production costs, precision, and patient satisfaction.
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17
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Chao D, Chang TL. Use of zirconia onlays in a maxillary removable implant-supported denture: A clinical report. J Prosthet Dent 2023; 129:251-256. [PMID: 34218903 DOI: 10.1016/j.prosdent.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
A common complication with the use of acrylic resin denture teeth is wear of the occlusal surfaces. Modifying the occlusal surfaces with gold onlays has been suggested to combat this phenomenon. This clinical report describes the use of zirconia as an alternative material on a patient with increased tendencies for occlusal wear. The advantages of using zirconia include wear resistance, decreased cost, and straightforward fabrication.
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Affiliation(s)
- Denny Chao
- Clinical Assistant Professor, Division of Advanced Prosthodontics, Biomaterial, and Hospital Dentistry, The Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, Calif.
| | - Ting-Ling Chang
- Clinical Professor, Division of Advanced Prosthodontics, Biomaterial, and Hospital Dentistry, The Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, Calif
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18
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Zuercher AN, Ioannidis A, Hüsler J, Mehl A, Hämmerle CHF, Thoma DS. Randomized controlled pilot study assessing efficacy, efficiency, and patient-reported outcomes measures of chairside and labside single-tooth restorations. J ESTHET RESTOR DENT 2023; 35:74-83. [PMID: 35421283 DOI: 10.1111/jerd.12909] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To test whether or not a chairside workflow (CHAIR) is similar to a labside workflow (LAB) in terms of efficacy (primary outcome) and efficiency (secondary outcome). MATERIAL AND METHODS Eighteen subjects in need of a single-tooth restoration in the posterior region of the maxilla or mandible were consecutively recruited and randomly assigned to the CHAIR or LAB workflow. Patient-reported outcome measures (PROMs; efficacy) were assessed using a questionnaire with visual analog scale. The white AEsthetic score (WES) was applied to evaluate the AEsthetic outcome objectively. The clinical and laboratory time (efficiency) were recorded. Nonparametric methods were applied for the group comparisons. RESULTS The overall median AEsthetic evaluation after treatment was 10 (interquartile range = IQR: 9.5-10) in group CHAIR and 10 (IQR: 9.5-10) in-group LAB (Mann-Whitney [MW] test p = 1.000). The WES amounted to 4 (IQR: 3-5) (CHAIR) and to 8 (IQR: 7-9) (LAB) (MW test p < 0.0001). The median total working time for the clinician in-group CHAIR was 49.9 min. (IQR: 40.9-63.7) and 41.4 min. (IQR: 37.2-58.2) in-group LAB (MW test p = 0.387). CONCLUSIONS Subjective PROMs of single-tooth supported restorations fabricated in a CHAIR or LAB workflow led to similar scores of patients' satisfaction and a moderate negative correlation for the objective evaluation of the clinician in the LAB workflow. CLINICAL SIGNIFICANCE PROMs can be considered a key element in the decision-making process for restoring single-tooth restorations. The patients' perception of AEsthetics was similar for the CHAIR or LAB workflows. The additional efforts undertaken with the LAB workflow did not result in a patient benefit when compared to a CHAIR workflow.
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Affiliation(s)
- Anina N Zuercher
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Alexis Ioannidis
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jürg Hüsler
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Albert Mehl
- Department of Computerized Restorative Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Karasan D, Sailer I, Lee H, Demir F, Zarauz C, Akca K. Occlusal adjustment of 3-unit tooth-supported fixed dental prostheses fabricated with complete-digital and -analog workflows: A crossover clinical trial. J Dent 2023; 128:104365. [PMID: 36403691 DOI: 10.1016/j.jdent.2022.104365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 10/31/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
AIM This prospective crossover clinical trial aimed to compare the complete-digital and -analog workflows in terms of occlusal adjustment of 3-unit tooth-supported fixed dental prostheses, operator, and patient preferences. MATERIALS AND METHOD This study included twelve patients receiving fourteen 3-unit posterior FDPs. 2 FDPs were made for each restoration site: one fabricated in complete-digital workflow comprising intraoral scan with static bite registration (Trios 3) and a monolithic zirconia FDP (test); the other fabricated in complete-analog workflow comprising conventional impression/face-bow transfer and a porcelain-fused-to-metal FDP (control). The FDPs (n=28) were intraorally/provisionally fixed, and quadrant-like intraoral scans were taken for every FDP before & after their occlusal adjustments. Pre- and post-adjustment scans of each FDP were then superimposed using best-fit alignment (GOM Inspect) to measure the volumetric occlusal adjustment amount (mm3) (3Matic) (Mann Whitney U, α=0.05). The patient and operator experience for digital and analog workflows were evaluated using visual analog scales (Wilcoxon test, α=0.05). RESULTS Mean occlusal adjustments were 7.63 mm3 [±7.02] and 25.95 mm3 [±39.61] for test and control groups, respectively. The volumetric adjustment difference was clinically noticeable but not significant (P=0.12). The impression and digital workflow adjustment were perceived more favorably by both operator (P=0.003, P=0.046, respectively) and the patients (P=0.003, P=0.002, respectively). CONCLUSIONS Within the limitations of this clinical study, the complete digital workflow with digital static bite-registration provided high occlusal accuracy for short-span tooth-supported FDPs. In addition, the patient and operator preferences significantly favored the digital workflow. CLINICAL SIGNIFICANCE Complete-digital workflow employing intraoral scanning and model-free fabrication of monolithic-Zr short-span tooth-supported FDPs offers an effective treatment modality with sufficient occlusal accuracy. Therefore complete-digital workflow is a valid alternative for complete-analog workflow comprising conventional impression, face-bow transfer, and use of a semi-adjustable articulator.
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Affiliation(s)
- Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Hyeonjong Lee
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Fatmanur Demir
- Department of Prosthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Cristina Zarauz
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Kivanc Akca
- Department of Prosthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Bonfante EA, Calamita M, Bergamo ETP. Indirect restorative systems-A narrative review. J ESTHET RESTOR DENT 2023; 35:84-104. [PMID: 36688803 DOI: 10.1111/jerd.13016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The background and clinical understanding of the properties of currently available indirect restorative systems and fabrication methods is, along with manufacturer and evidence-based literature, an important starting point to guide the clinical selection of materials for tooth and/or implant supported reconstructions. Therefore, this review explores most indirect restorative systems available in the market, especially all-ceramic, along with aspects of manufacturing process, clinical survival rates, and esthetic outcomes. OVERVIEW Progressive incorporation of new technologies in the dental field and advancements in materials science have enabled the development/improvement of indirect restorative systems and treatment concepts in oral rehabilitation, resulting in reliable and predictable workflows and successful esthetic and functional outcomes. Indirect restorative systems have evolved from metal ceramics and polymers to glass ceramics, polycrystalline ceramics, and resin-matrix ceramics, aiming to improve not only biological and mechanical properties, but especially the optical properties and esthetic quality of the reconstructions, in attempt to mimic natural teeth. CONCLUSIONS Based on several clinical research, materials, and patient-related parameters, a decision tree for the selection of indirect restorative materials was suggested to guide clinicians in the rehabilitation process. CLINICAL SIGNIFICANCE The pace of materials development is faster than that of clinical research aimed to support their use. Since no single material provides an ideal solution to every case, professionals must continuously seek information from well designed, long-term clinical trials in order to incorporate or not new materials and technological advancements.
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Affiliation(s)
- Estevam A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| | - Marcelo Calamita
- Department of Restorative Dental Sciences at the University of Florida, Gainesville, Florida, USA
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
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Time efficiency and efficacy of a centralized computer-aided-design/computer-aided-manufacturing workflow for implant crown fabrication: A prospective controlled clinical study. J Dent 2022; 127:104332. [PMID: 36252858 DOI: 10.1016/j.jdent.2022.104332] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess time efficiency and the efficacy of the prosthetic manufacturing for implant crown fabrication in a centralized workflow applying computer aided design and computer aided manufacturing (CAD-CAM). MATERIAL AND METHODS Fifty-nine patients with one posterior implant each, were randomly allocated to either a centralized digital workflow (c-DW, test) or a laboratory digital workflow (l-DW, control). Patients were excluded from efficiency and efficacy analyses, if any additional restoration than this single implant crown had to be fabricated. A customized titanium abutment and a monolithic zirconia crown were fabricated in the c-DW. In the l-DW, models were digitalized for CAD-CAM fabrication of a monolithic zirconia crown using a standardized titanium base abutment. Time for impression, laboratory operating and delivery time were recorded. The efficacy of the prosthetic manufacturing was evaluated at try-in and at delivery. Data was analyzed descriptively. Statistical analyses using student's unpaired t- and paired Wilcoxon were performed (p < 0.05). RESULTS At impression taking, 12 patients (c-DW) and 19 patients (l-DW) were included. The impression time was 9.4±3.5 min (c-DW) and 15.1 ± 4.6 min (l-DW) (p < 0.05). The laboratory operating time was 130 ± 31 min (c-DW) and 218.0±8 min (l-DW) (p < 0.05). The delivery time was significantly longer in the c-DW (5.9 ± 3.5 1 days) as compared to the l-DW (0.5±0.05 days). At try-in and at delivery, efficacy of prosthetic manufacturing was similar high in both workflows. CLINICAL RELEVANCE The c-DW was more time efficient compared to the lab-DW and rendered a similar efficacy of prosthetic manufacturing.
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22
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Camargo B, Willems E, Jacobs W, Van Landuyt K, Peumans M, Zhang F, Vleugels J, Van Meerbeek B. 3D printing and milling accuracy influence full-contour zirconia crown adaptation. Dent Mater 2022; 38:1963-1976. [DOI: 10.1016/j.dental.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/26/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
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23
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Yang CH, Cheng CW, Ye SY, Chien CH. A double blinded trial to compare the patient satisfaction and crown accuracy of two different intraoral scanners for the fabrication of monolithic lithium disilicate single crowns. J Dent Sci 2022. [DOI: 10.1016/j.jds.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Hjerppe J, Jung RE, Hämmerle CH, Özcan M, Mühlemann S. Mechanical stability of fully personalized, abutment-free zirconia implant crowns on a novel implant-crown interface. J Dent 2022; 121:104121. [PMID: 35395344 DOI: 10.1016/j.jdent.2022.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To test the failure load and failure mode of a novel implant-crown interface specifically designed for the fabrication of fully personalized, abutment-free monolithic zirconia CAD-CAM crowns compared to conventional implant-abutment interfaces involving prefabricated or centrally manufactured abutments for zirconia CAD-CAM crowns. METHODS Implants (N=48) were divided into groups (n=12) according to different implant-abutment interface designs: (1) internal implant connection with personalized, abutment-free CAD-CAM crowns (Abut-Free-Zr), (2) internal conical connection with customized, centrally manufactured zirconia CAD-CAM abutments (Cen-Abut-Zr), (3) prefabricated titanium base abutments from manufacturer 1 (Ti-Base-1), (4) additional prefabricated titanium base abutments from manufacturer 2 (Ti-Base-2). All specimens were restored with a screw-retained monolithic zirconia CAD-CAM molar crown and subjected to thermomechanical aging (1.200.000 cycles, 49 N, 1.67 Hz, 30° angulation, thermocycling 5-50°C). Static load until failure was applied in a universal testing machine. Failure modes were analyzed descriptively under digital microscope. Mean failure load values were statistically analyzed at a significance level of p<0.05. RESULTS All specimens survived thermomechanical aging. The mean failure loads varied between 1332 N (Abut-Free-Zr) and 1601 N (Ti-Base-2), difference being significant between these groups (p<0.05). No differences between the other groups were seen. The predominant failure mode per group was crown fracture above implant connection (Abut-Free-Zr, 75%), abutment fracture below implant neck (Cen-Abut-Zr, 83%), crown fracture leaving an intact abutment (Ti-Base-1/Ti-Base-2 100%). CONCLUSIONS Implant-crown interface with fully personalized, abutment-free monolithic CAD-CAM zirconia crowns exhibited similar failure loads as conventional implant-abutment interfaces (except group Ti-Base-2) involving CAD-CAM crowns with prefabricated or centrally manufactured abutment. CLINICAL SIGNIFICANCE The new implant connection simplifies the digital workflow for all-ceramic implant reconstructions. The specific design of the implant-crown interface allows the fabrication of fully personalized, abutment-free zirconia implant crowns both in-house and in-laboratory without the need of a prefabricated abutment or central manufacturing.
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Affiliation(s)
- Jenni Hjerppe
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Christoph Hf Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
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Almiro M, Marinho B, Delgado AHS, Rua J, Monteiro P, Santos IC, Proença L, Mendes JJ, Gresnigt MMM. Increasing Acid Concentration, Time and Using a Two-Part Silane Potentiates Bond Strength of Lithium Disilicate-Reinforced Glass Ceramic to Resin Composite: An Exploratory Laboratory Study. MATERIALS 2022; 15:ma15062045. [PMID: 35329495 PMCID: PMC8950098 DOI: 10.3390/ma15062045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/21/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
There is still a lack of consensus concerning the recommended etching concentration, application time and type of silane when bonding lithium disilicate-reinforced glass ceramics manufactured by CAD/CAM. The purpose of this study was thus to conduct an in vitro study which investigates the influence of hydrofluoric acid (HF) concentration, etching time and silane type on the microtensile bond strength (μTBS) of lithium disilicate to resin composites. Thirty-nine IPS e.max CAD blocks were randomly divided between thirteen groups (n = 3). The variables were HF concentration (9.5 or 4.9%), etching time (20 or 60 s) and silane type (Bis-Silane, Monobond Plus and ESPE Sil Silane). The blocks were cut into beams, aged for 10,000 cycles in a thermocycler and submitted to tensile stress to determine μTBS. A control group featuring the Monobond Etch & Prime (MEP) agent that combines etching/silanisation into a simultaneous process was also added. This group was discarded from the analysis due to only having pre-test failures. The data were analysed using a three-way ANOVA (α = 0.05). The HF concentration, etching time and silane type significantly influenced μTBS (p < 0.001). Significant interactions between time and silane type (p = 0.004), HF concentration and silane type (p < 0.001) and among the three factors (p < 0.001) were noted. Etching lithium disilicate with 9.5% HF (60 s), followed by the application of Bis-Silane, resulted in the highest μTBS (16.6 ± 9.0 MPa). The highest concentration and etching time under study, combined with a two-part silane, resulted in the highest bond strength, while the application of MEP showed a complete pre-test failure.
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Affiliation(s)
- Matilde Almiro
- Department of Conservative Dentistry, Instituto Universitário Egas Moniz (IUEM), Monte de Caparica, 2829-511 Almada, Portugal; (M.A.); (B.M.)
| | - Beatriz Marinho
- Department of Conservative Dentistry, Instituto Universitário Egas Moniz (IUEM), Monte de Caparica, 2829-511 Almada, Portugal; (M.A.); (B.M.)
| | - António H. S. Delgado
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Monte de Caparica, 2829-511 Almada, Portugal; (A.H.S.D.); (J.R.); (P.M.); (I.C.S.); (L.P.); (J.J.M.)
- Division of Biomaterials and Tissue Engineering, Eastman Dental Institute, University College London (UCL), London NW3 2PF, UK
| | - João Rua
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Monte de Caparica, 2829-511 Almada, Portugal; (A.H.S.D.); (J.R.); (P.M.); (I.C.S.); (L.P.); (J.J.M.)
| | - Paulo Monteiro
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Monte de Caparica, 2829-511 Almada, Portugal; (A.H.S.D.); (J.R.); (P.M.); (I.C.S.); (L.P.); (J.J.M.)
| | - Inês Caetano Santos
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Monte de Caparica, 2829-511 Almada, Portugal; (A.H.S.D.); (J.R.); (P.M.); (I.C.S.); (L.P.); (J.J.M.)
| | - Luís Proença
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Monte de Caparica, 2829-511 Almada, Portugal; (A.H.S.D.); (J.R.); (P.M.); (I.C.S.); (L.P.); (J.J.M.)
| | - José João Mendes
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Monte de Caparica, 2829-511 Almada, Portugal; (A.H.S.D.); (J.R.); (P.M.); (I.C.S.); (L.P.); (J.J.M.)
| | - Marco M. M. Gresnigt
- University Medical Center Groningen, Department of Restorative Dentistry and Biomaterials, Center for Dentistry and Oral Hygiene, University of Groningen, 9713 AV Groningen, The Netherlands
- Department of Special Dental Care, Martini Hospital, 9728 NT Groningen, The Netherlands
- Faculty of Health Sciences, University Arthuro Prat, Iquique 2120, Chile
- Correspondence:
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Bandiaky ON, Le Bars P, Gaudin A, Hardouin JB, Cheraud-Carpentier M, Mbodj EB, Soueidan A. Comparative assessment of complete-coverage, fixed tooth-supported prostheses fabricated from digital scans or conventional impressions: A systematic review and meta-analysis. J Prosthet Dent 2022; 127:71-79. [PMID: 33143901 DOI: 10.1016/j.prosdent.2020.09.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM Intraoral scanners have significantly improved over the last decade. Nevertheless, data comparing intraoral digital scans with conventional impressions are sparse. PURPOSE The purpose of this systematic review and meta-analysis was to determine the impact of impression technique (digital scans versus conventional impressions) on the clinical time, patient comfort, and marginal fit of tooth-supported prostheses. MATERIAL AND METHODS The authors conducted a literature search based on the Population, Intervention, Comparison, and Outcome (PICO) framework in 3 databases to identify clinical trials with no language or date restrictions. The mean clinical time, patient comfort, and marginal fit values of each study were independently extracted by 2 review authors and categorized according to the scanning or impression method. The authors assessed the study-level risk of bias. RESULTS A total of 16 clinical studies met the inclusion criteria. The mean clinical time was statistically similar for digital scan procedures (784 ±252 seconds) and for conventional impression methods (1125 ±159 seconds) (P>.05). The digital scan techniques were more comfortable for patients than conventional impressions; the mean visual analog scale score was 67.8 ±21.7 for digital scans and 39.6 ±9.3 for conventional impressions (P<.05). The mean marginal fit was 80.9 ±31.9 μm and 92.1 ±35.4 μm for digital scan and conventional impressions, respectively, with no statistically significant difference (P>.05). CONCLUSIONS Digital scan techniques are comparable with conventional impressions in terms of clinical time and marginal fit but are more comfortable for patients than conventional impression techniques.
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Affiliation(s)
- Octave Nadile Bandiaky
- Graduate student, Graduate Prosthodontics, Department of Odontology, University of Dakar, Dakar, Senegal
| | - Pierre Le Bars
- Associate Professor, Division of Fixed Prosthodontics, CHU Nantes, Nantes, France
| | - Alexis Gaudin
- Associate Professor Biostatistics, UMR 1246 INSERM SPHERE "MethodS in Patients-Centered Outcomes and HEalth ResEarch", Universities of Nantes and Tours, Nantes, France
| | - Jean Benoit Hardouin
- Associate Professor of Endodontics and Restorative Dentistry, Department of Endodontics and Restorative Dentistry, University of Nantes, Nantes, France
| | | | - Elhadj Babacar Mbodj
- Professor, Clinic of Fixed and Removable Prosthodontics, Department of Odontology, University of Dakar, Dakar, Senegal
| | - Assem Soueidan
- Professor of Periodontology, Department of Periodontology, Rmes U1229, University of Nantes, Nantes, France.
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Bergamo ETP, Yamaguchi S, Lopes ACO, Coelho PG, de Araújo-Júnior ENS, Benalcázar Jalkh EB, Zahoui A, Bonfante EA. Performance of crowns cemented on a fiber-reinforced composite framework 5-unit implant-supported prostheses: in silico and fatigue analyses. Dent Mater 2021; 37:1783-1793. [PMID: 34588130 DOI: 10.1016/j.dental.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize the biomechanical performance of fiber-reinforced composite 5-unit implant-supported fixed dental prostheses (FDPs) receiving individually milled crowns by insilico and fatigue analyses. METHODS Eighteen implant-supported five-unit fiber-reinforced composite frameworks with an individually prepared abutment design were fabricated, and ninety resin-matrix ceramic crowns were milled to fit each abutment. FDPs were subjected to step-stress accelerated-life testing with load delivered at the center of the pontic and at 2nd molar and 1st premolar until failure. The reliability of the prostheses combining all loaded data and of each loaded tooth was estimated for a mission of 50,000 cycles at 300, 600 and 900 N. Weibull parameters were calculated and plotted. Fractographic and finite element analysis were performed. RESULTS Fatigue analysis demonstrated high probability of survival at 300 N, with no significant differences when the set load was increased to 600 and 900 N. 1st and 2nd molar dataset showed high reliability at 300 N, which remained high for the higher load missions; whereas 1st premolar dataset showed a significant decrease when the reliability at 300 N was compared to higher load missions. The characteristic-strength of the combined dataset was 1252 N, with 1st molar dataset presenting higher values relative to 2nd molar and 1st premolar, both significantly different. Failure modes comprised chiefly cohesive fracture within the crown material originated from cracks at the occlusal area, matching the maximum principal strain location. SIGNIFICANCE Five-unit implant-supported FDP with crowns individually cemented in a fiber-reinforced composite framework presented a high survival probability. Crown fracture comprised the main failure mode.
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Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
| | - Satoshi Yamaguchi
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, 565-0871, Suita, Osaka, Japan
| | - Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
| | - Paulo G Coelho
- Department of Biomaterials, New York University College of Dentistry, New York, NY, USA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA; Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Everardo N S de Araújo-Júnior
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
| | - Ernesto B Benalcázar Jalkh
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil; Department of Biomaterials, New York University College of Dentistry, New York, NY, USA.
| | - Abbas Zahoui
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
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Derksen W, Tahmaseb A, Wismeijer D. Randomized Clinical Trial comparing clinical adjustment times of CAD/CAM screw-retained posterior crowns on ti-base abutments created with digital or conventional impressions. One-year follow-up. Clin Oral Implants Res 2021; 32:962-970. [PMID: 34080238 PMCID: PMC8453558 DOI: 10.1111/clr.13790] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/30/2020] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this randomized clinical trial was to compare the required time of potential clinical adjustments of posterior screw-retained monolithic zirconia implant retained crowns based on intraoral optical scanning (IOS) or conventional impressions. MATERIALS AND METHODS Patients with posterior tissue level implants (Straumann RN) replacing solitary teeth were recruited. Of all patients, impressions were taken with both an IOS (3M™ TDS) and a conventional (polyether) pick-up impression. Randomization was performed after impression taking and patients were to receive either a crown based on the digital or the conventional impression. The time required for adjustments at placement was recorded. Additionally, restoration survival and mechanical complications with a follow-up of one year were documented. RESULTS Thirty two patients with 45 implants were included: 23 restorations in the test (IOS) and 22 in the control (conventional) group. The average adjustment time was 3.35 min (SD ± 3.38, range: 0-11 min) for the digital versus 6.09 min (SD ± 4.63, range: 0-18 min) for the conventional impressions (p = .039). A proper fit (no adjustments required) was achieved 39,1% in the digital and 18,2% conventional group respectively. All 45 restorations could be placed within the two planned appointments and only two minor mechanical complications occurred during the first year of function. CONCLUSIONS The use of IOS resulted in shorter adjustment times at try-in than conventional impressions for solitary CAD/CAM implant restorations. Screw-retained solitary monolithic zirconia restorations on ti-base abutments show low complication- and survival rates in the short term.
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Affiliation(s)
- Wiebe Derksen
- Section of Oral Implantology and Prosthetic DentistryAcademic Centre for Dentistry Amsterdam (ACTA)AmsterdamThe Netherlands
| | - Ali Tahmaseb
- Section of Oral Implantology and Prosthetic DentistryAcademic Centre for Dentistry Amsterdam (ACTA)AmsterdamThe Netherlands
| | - Daniel Wismeijer
- Section of Oral Implantology and Prosthetic DentistryAcademic Centre for Dentistry Amsterdam (ACTA)AmsterdamThe Netherlands
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Clinical Evaluation of Resin Composite CAD/CAM Restorations Placed by Undergraduate Students. J Clin Med 2021; 10:jcm10153269. [PMID: 34362055 PMCID: PMC8348683 DOI: 10.3390/jcm10153269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/17/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
To evaluate the clinical outcomes of resin composite CAD/CAM restorations in a prospective cohort study, and to assess patient and operator satisfaction after restoration placement, 59 indirect resin composite were placed by supervised undergraduate students, of which 43 restorations were followed over a mean period of 28 months (14–44 months) and evaluated using USPHS criteria. Patient and operator satisfaction levels were assessed using a visual analogue scale (VAS) after restoration placement. A total of 37 patients and 47 restorations were included for further study. Four teeth were extracted—three due to extensive drug-induced secondary caries in the same patient, and one tooth due to large periapical periodontitis after 44 months of service. The overall survival rate was 91.4%, and success rate was 87.2%. Differences between baseline and endpoint scores were significant for marginal discoloration (p < 0.05) and adaptation (p < 0.001). Color match (p < 0.05) and surface texture (p < 0.001) differed significantly, affecting all restoration types. VAS scores for patient and operator satisfaction showed a significant rank correlation (p < 0.01), and pairwise comparison showed significant differences for mean overall patient and operator VAS scores (p < 0.001). Lava Ultimate CAD/CAM may be considered a suitable material for overlays and endocrown restorations when combined with IDS, air abrasion, and MDP-containing adhesive systems. Marginal disintegration may present in inlays and onlays over time.
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Bergamo ETP, Bastos TMC, Lopes ACO, de Araujo Júnior ENS, Coelho PG, Benalcazar Jalkh EB, Zahoui A, Bonfante EA. Physicochemical and mechanical characterization of a fiber-reinforced composite used as frameworks of implant-supported prostheses. Dent Mater 2021; 37:e443-e453. [PMID: 33865619 DOI: 10.1016/j.dental.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/31/2020] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To characterize the physicochemical and mechanical properties of a milled fiber-reinforced composite (FRC) for implant-supported fixed dental prostheses (FDPs). METHODS For FRC characterization, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), X-ray diffraction, Fourier-transformed infrared spectrometry, simultaneous thermogravimetric analysis and differential scanning calorimetry were performed. For fatigue testing, 3-unit FRC frameworks were fabricated with conventional (9 mm2 connector area) and modified designs (12 mm2 connector area and 2.5 mm-height lingual extension). A hybrid resin composite was veneered onto the frameworks. FDPs were subjected to step-stress accelerated-life fatigue testing until fracture or suspension. Use level probability Weibull curves at 300 N were plotted and the reliability for 100,000 cycles at 300, 600 and 800 N was calculated. Fractographic analysis was performed by stereomicroscope and SEM. RESULTS The FRC consisted of an epoxy resin (∼25%) matrix reinforced with inorganic particles and glass fibers (∼75%). Multi-layer continuous regular-geometry fibers were densely arranged in a parallel and bidirectional fashion in the resin matrix. Fatigue analysis demonstrated high probability of survival (99%) for FDPs at 300 N, irrespective of framework design. Conventional FDPs showed a progressive decrease in the reliability at 600 (84%) and 800 N (19%), whereas modified FDPs reliability significantly reduced only at 800 N (75%). The chief failure modes for FRC FDPs were cohesive fracture of the veneering composite on lower loads and adhesive fracture of the veneering composite at higher loads. SIGNIFICANCE Milled epoxy resin matrix reinforced with glass fibers composite resulted in high probability of survival in the implant-supported prosthesis scenario.
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Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil.
| | - Tiago M C Bastos
- Department of Physics, Technological Institute of Aeronautics, 50 Marechal Eduardo Gomes, 12228-900, São José dos Campos, SP, Brazil
| | - Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Everardo N S de Araujo Júnior
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, Hansjorg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, 345 24th Street, 10010, New York City, NY, USA
| | - Ernesto B Benalcazar Jalkh
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil; Department of Biomaterials and Biomimetics, Hansjorg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, 345 24th Street, 10010, New York City, NY, USA
| | - Abbas Zahoui
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
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No-Cortes J, Son A, Ayres AP, Markarian RA, Attard NJ, Cortes ARG. Effect of varying levels of expertise on the reliability and reproducibility of the digital waxing of single crowns: A preliminary in vitro study. J Prosthet Dent 2020; 127:128-133. [PMID: 33198990 DOI: 10.1016/j.prosdent.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
STATEMENT OF PROBLEM The digital waxing of single crowns can be affected by the quality of intraoral scans and use of computer-aided design (CAD) software programs. However, clinical outcomes of the resulting crowns are also affected by computer-aided manufacturing (CAM) methodologies. Studies on the effect of different levels of expertise on digital waxing are lacking. PURPOSE The purpose of this in vitro study was to assess the impact of different levels of expertise on the reliability and reproducibility of margin outlining during digital waxing. MATERIAL AND METHODS Thirty analogs of implant stock abutments (Ø4.8×4 mm) were embedded into resin blocks. To simulate different clinical situations, abutments were divided into 3 groups: 10 abutments (group GOS) received artificial gingiva and were scanned with an open system intraoral scanner, while 10 abutments with (group GIS) and 10 abutments without artificial gingiva (group IS) were scanned with an intraoral scanner within an integrated CAD-CAM system. All resulting standard tessellation language (STL) files were used by 2 different observers (an experienced CAD professional and a clinician with basic CAD knowledge) to digitally design a left mandibular central incisor in the same software program. All resulting digital crown designs were exported to STL files to assess crown margin accuracy at the coupling interface by superimposition with the control STL file of the scan body designed for the same abutment by the manufacturer. For this purpose, a CAD software program was used to automatically calculate median, minimum, and maximum deviations of margins in millimeters. Statistically significant pairwise differences among groups and between observers were assessed with the Wilcoxon signed-rank test (α=.05). RESULTS For the CAD professional, median deviations between designed crown STL files and the control STL of the scan body were 0.08 mm (range: 0.04 to 0.15) for group GOS; 0.10 mm (range: 0.06 to 0.18) for group GIS; and 0.05 mm (range: 0.03 to 0.08) for group IS. For the clinician, median deviations were 0.08 mm (range: 0.04 to 0.12) for group GOS; 0.11 mm (range: 0.07 to 0.17) for group GIS; and 0.05 mm (range: 0.04 to 0.11) for group IS. There were no significant differences between observers (P>.05). However, statistically significant differences were found between group IS and the other 2 groups (P=.001) but not between groups GOS and GIS (P>.05). CONCLUSIONS The present findings suggest that a digital wax pattern made with a dental CAD software program is not affected by varying levels of expertise but might be affected by subgingival margins.
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Affiliation(s)
- Juliana No-Cortes
- PhD candidate, Department of Dental Surgery, Faculty of Dental Surgery, University of Malta (UM), Msida, Malta
| | - Andrea Son
- Research Analyst, Department of Research and Development, Plenum Bioengenharia (PLENUM), São Paulo, SP, Brazil
| | - Ana Paula Ayres
- Graduate student, Department of Oral Radiology, School of Dentistry, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Roberto Adrian Markarian
- Postdoctoral Fellow, Department of Oral Implantology, School of Dentistry, Faculdades São Leopoldo Mandic (SLM), Campinas-SP, Brazil
| | - Nikolai J Attard
- Full Professor, Department of Oral Rehabilitation and Community Care, Faculty of Dental Surgery, University of Malta (UM), Msida, Malta
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Son K, Yu BY, Lee JH, Son YT, Lee KB. Comparison of Intaglio Surface Adjustment in the Oral Cavity for Lithium Disilicate Crowns Fabricated Using Different Scanners. J Prosthodont 2020; 30:276-281. [PMID: 32924226 DOI: 10.1111/jopr.13259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE A clinical study to evaluate the intraoral adjustment of crowns fabricated using different scanners. MATERIALS AND METHODS A total of 15 patients requiring single ceramic crowns were recruited. Impressions were made according to four protocols: a conventional approach and using three intraoral scanners (IOSs) (CS3600 (Carestream Dental, Atlanta, GA), i500 (Medit, Seoul, Republic of Korea), and EZIS PO (DDS, Seoul, Republic of Korea)). Four crowns per patient were fabricated using lithium disilicate ceramic. An experienced dentist performed the internal adjustment in the oral cavity. Three-dimensional analysis was conducted using an inspection software program (Geomagic Control X; 3D Systems, Rock Hill, SC). Statistical analysis was conducted using one-way analysis of variance and Tukey's honest significance difference tests (α = 0.05). RESULTS A significant difference was observed in the intraoral adjustment among the conventional approach and the three IOSs (F = 213.7, p < 0.001). Crowns fabricated by conventional impressions (20.1 ± 1.4 µm) displayed better three-dimensional conformity before and after intraoral adjustment than IOS groups (29.6 ± 4.3 µm) (p < 0.001). CONCLUSIONS Crowns fabricated using conventional impressions required fewer intraoral adjustments of the intaglio surface than those fabricated using IOSs.
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Affiliation(s)
- Keunbada Son
- Department of Dental Science, Graduate School, Kyungpook National University, Daegu, Republic of Korea.,Advanced Dental Device Development Institute (A3DI), Kyungpook National University, Daegu, Republic of Korea
| | - Beom-Young Yu
- Department of Dental Science, Graduate School, Kyungpook National University, Daegu, Republic of Korea.,Advanced Dental Device Development Institute (A3DI), Kyungpook National University, Daegu, Republic of Korea
| | - Jeong-Hyeon Lee
- Advanced Dental Device Development Institute (A3DI), Kyungpook National University, Daegu, Republic of Korea.,Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Young-Tak Son
- Department of Dental Science, Graduate School, Kyungpook National University, Daegu, Republic of Korea.,Advanced Dental Device Development Institute (A3DI), Kyungpook National University, Daegu, Republic of Korea
| | - Kyu-Bok Lee
- Advanced Dental Device Development Institute (A3DI), Kyungpook National University, Daegu, Republic of Korea.,Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
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Cheng CW, Ye SY, Chien CH, Chen CJ, Papaspyridakos P, Ko CC. Randomized clinical trial of a conventional and a digital workflow for the fabrication of interim crowns: An evaluation of treatment efficiency, fit, and the effect of clinician experience. J Prosthet Dent 2020; 125:73-81. [PMID: 32057487 DOI: 10.1016/j.prosdent.2019.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 07/26/2019] [Accepted: 08/15/2019] [Indexed: 11/16/2022]
Abstract
STATEMENT OF PROBLEM Limited information is available regarding the fabrication of tooth-supported interim single crowns (SCs) with either a digital or a conventional workflow. PURPOSE The purpose of this randomized clinical trial was to compare the time efficiency and fit of interim crowns fabricated by using either a digital or a conventional workflow. MATERIAL AND METHODS Forty participants in need of posterior tooth-supported SCs were enrolled and randomly allocated to either the digital or conventional group. In the digital group, the interim SCs were fabricated by using digital sextant scans and computer-aided design and computer-aided manufacturing (CAD-CAM) technology without definitive casts. The conventional group included conventional impressions and direct fabrication of the interim restorations intraorally. Five experienced and 5 less experienced clinicians were randomly assigned to fabricate the interim SCs. The total fabrication time (laboratory and clinical) was recorded for time efficiency. The fit assessment included marginal fit, proximal contact, occlusal contact, and crown morphology. The evaluated parameters were analyzed with the Mann-Whitney U Test (α=.05). RESULTS The digital workflow required significantly less total fabrication time (laboratory and clinical) than the conventional workflow (P<.001). The less-experienced clinicians needed longer clinical time with the conventional workflow than the experienced ones (P=.023). In contrast, the laboratory time and total fabrication time were shorter for less-experienced clinicians using the digital workflow (P=.005 and P=.015). The interim SCs fabricated with the digital workflow had significantly better fit and occlusal contacts than those fabricated with the conventional workflow (P=.005 and P<.001). With the digital workflow, the interim SCs made by less-experienced clinicians were of the same quality as those made by experienced clinicians. When using the conventional workflow, the fit of the experienced clinicians was significantly better than that of the less-experienced clinicians. CONCLUSIONS The interim SCs fabricated with a digital workflow required a shorter fabrication time and resulted in better fit than those fabricated with a conventional workflow, especially for less-experienced clinicians.
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Affiliation(s)
- Chih-Wen Cheng
- Assistant Professor, Division of Prosthodontics, Department of Dentistry, Chi Mei Medical Center, Tainan, Taiwan, Republic of China
| | - Sung-Ying Ye
- Clinical Instructor, Division of Prosthodontics, Department of Dentistry, Chi Mei Medical Center, Tainan, Taiwan, Republic of China
| | - Chia-Hui Chien
- Assistant Professor, Division of Prosthodontics, Department of Dentistry, Chi Mei Medical Center, Tainan, Taiwan, Republic of China
| | - Chun-Jung Chen
- Assistant Professor, Division of Periodontics, Department of Dentistry, Chi Mei Medical Center, Tainan, Taiwan, Republic of China
| | - Panos Papaspyridakos
- Assistant Professor, Division of Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, Mass
| | - Ching-Chang Ko
- Professor, Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC.
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McCracken MS, Litaker MS, Thomson AES, Slootsky A, Gilbert GH. Laboratory Technician Assessment of the Quality of Single-Unit Crown Preparations and Impressions as Predictors of the Clinical Acceptability of Crowns as Determined by the Treating Dentist: Findings from the National Dental Practice-Based Research Network. J Prosthodont 2020; 29:114-123. [PMID: 31893566 DOI: 10.1111/jopr.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In-laboratory assessment by laboratory technicians may offer insight to increase clinical success of dental crowns, and research in this area is lacking. MATERIALS AND METHODS Dentists in the National Dental Practice-Based Research Network enrolled patients in a study about single-unit crowns; laboratory technicians evaluated the quality of tooth preparations and impressions. The primary outcome for each crown was clinical acceptability (CAC), as judged by the treating dentist. A secondary outcome was "Goodness of Fit (GOF)," a composite score of several aspects of clinical fit, also judged by the study dentist. A mixed-effects logistic regression was used to analyze associations between laboratory technician ratings and the CAC and GOF. RESULTS Dentists (n = 205) evaluated 3731 crowns. Technicians ranked the marginal detail of impressions as good or excellent in 92% of cases; other aspects of the impression were ranked good or excellent 88% of the time. Regarding tooth preparation, about 90% of preparations were considered adequate (neither excessive nor inadequate reduction). Factors associated with higher CAC were more preparation taper, and use of optical imaging. Factors associated with better GOF were higher impression quality, greater occlusal reduction, more preparation taper, and optical imaging. CONCLUSIONS Overall quality of preparations and impressions was very high, as evaluated by laboratory technicians. Several clinical parameters were associated with higher CAC and GOF. Clinicians who struggle with crown remakes might consider less conservative tooth preparation, as well as using digital impression technology.
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Affiliation(s)
- Michael S McCracken
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Mark S Litaker
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | | | - Alan Slootsky
- Department of Prosthodontics, Nova Southeastern University, College of Dental Medicine, Davie, FL.,Private Practice of Dentistry, Pompano Beach, FL
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
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Digital dentistry: The new state of the art - Is it disruptive or destructive? Dent Mater 2019; 36:9-24. [PMID: 31526522 DOI: 10.1016/j.dental.2019.08.103] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Summarizing the new state of the art of digital dentistry, opens exploration of the type and extent of innovations and technological advances that have impacted - and improved - dentistry. The objective is to describe advances and innovations, the breadth of their impact, disruptions and advantages they produce, and opportunities created for material scientists. METHODS On-line data bases, web searches, and discussions with industry experts, clinicians, and dental researchers informed the content. Emphasis for inclusion was on most recent publications along with innovations presented at trade shows, in press releases, and discovered through discussions leading to web searches for new products. RESULTS Digital dentistry has caused disruption on many fronts, bringing new techniques, systems, and interactions that have improved dentistry. Innovation has spurred opportunities for material scientists' future research. SIGNIFICANCE With disruptions intrinsic in digital dentistry's new state of the art, patient experience has improved. More restoration options are available delivering longer lifetimes, and better esthetics. Fresh approaches are bringing greater efficiency and accuracy, capitalizing on the interest, capabilities, and skills of those involved. New ways for effective and efficient inter-professional and clinician-patient interactions have evolved. Data can be more efficiently mined for forensic and epidemiological uses. Students have fresh ways of learning. New, often unexpected, partnerships have formed bringing further disruption - and novel advantages. Yes, digital dentistry has been disruptive, but the abundance of positive outcomes argues strongly that it has not been destructive.
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Delize V, Bouhy A, Lambert F, Lamy M. Intrasubject comparison of digital vs. conventional workflow for screw-retained single-implant crowns: Prosthodontic and patient-centered outcomes. Clin Oral Implants Res 2019; 30:892-902. [PMID: 31183902 DOI: 10.1111/clr.13494] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/09/2019] [Accepted: 02/13/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this intrasubject clinical study was to measure and compare prosthodontic and patient-reported outcome measures (PROMs) in the fabrication of implant-supported, all-ceramic single crowns with a full digital workflow and a conventional workflow. MATERIALS AND METHODS Thirty-one patients were subjected to first a digital (test group) and then a conventional impression (control group) at the same visit. From the intraoral optical scanner (IOS), a screw-retained, monolithic crown was delivered according to a complete digital workflow (no cast), whereas a veneered crown on a zirconia (Zi) frame was provided as a control treatment. Both crowns were assessed during the clinical stages of try-in. Prosthodontic outcomes (contact points, occlusion, PROMs, and esthetic results using the white esthetic score [WES]) were assessed. RESULTS Occlusion and interproximal contacts showed comparable results for the two workflows (p = 0.37 and p = 0.36, respectively), whereas the global WES was significantly higher (p < 0.0001) in the control group. Patient satisfaction scores, using visual analog scales (VAS), were significantly better for IOS than for conventional impressions (p = 0.0098). On the contrary, patients' perception of the esthetic outcomes showed significantly higher value (p < 0.0001) in the control group. CONCLUSIONS Both workflows allowed the delivery of ceramic crowns within two appointments. The clinical fit was acceptable in both groups. A better esthetic outcome, in both patients' and clinicians' opinions, was found in the control group. PROMs showed higher satisfaction with the IOS.
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Affiliation(s)
- Vincent Delize
- Department of Removable Prosthodontics, Faculty of Medicine, University of Liege, Liege, Belgium
| | - Alice Bouhy
- Department of Removable Prosthodontics, Faculty of Medicine, University of Liege, Liege, Belgium
| | - France Lambert
- Dental Biomaterials Research Unit, Department of Periodontology and Oral Surgery, CHU of Liege, Faculty of Medicine, University of Liege, Liege, Belgium
| | - Marc Lamy
- Department of Removable Prosthodontics, Faculty of Medicine, University of Liege, Liege, Belgium
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Rodrigues SB, Franken P, Celeste RK, Leitune VCB, Collares FM. CAD/CAM or conventional ceramic materials restorations longevity: a systematic review and meta-analysis. J Prosthodont Res 2019; 63:389-395. [PMID: 31303569 DOI: 10.1016/j.jpor.2018.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/23/2018] [Accepted: 11/09/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the difference in longevity of tooth-supported ceramic prostheses designed by conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) techniques. STUDY SELECTION Two reviewers searched the Web of Science, PubMed, SCOPUS and LILACS databases between 1966 and October 2017. Clinical studies that compared the survival rate of CAD/CAM against conventional restorations were included. RESULTS Eleven randomized controlled trials and three prospective studies were included, n=14. Three types of tooth-supported restorations were searched in the included studies: single crown, multiple-unit and partial ceramic crown. The follow-up of patients in the studies ranged from 24 to 84 months. A total of 1209 restorations had been placed in 957 patients in the included trials, and failures were analyzed by type and material restoration. From a total of 72 restoration failures, the CAD/CAM system resulted in a 1.84 (IC95%: 1.28-2.63) higher risk than conventional manufacturing of ceramic restoration. Nevertheless, when drop-outs were included as a failure risk, the CAD/CAM system resulted in a risk of 1.32 (IC95%: 1.10-1.58). Multilevel analysis of tooth-supported ceramic restorations, considering drop-outs as successes, resulted in rates of 1.48 and 2.62 failures per 100 restoration-years for the controls and CAD/CAM groups, respectively. Considering drop-outs as failures, we found rates of 4.23 and 5.88 failures per 100 restoration-years for the controls and CAD/CAM groups, respectively. CONCLUSIONS The meta-analysis results suggest that the longevity of a tooth-supported ceramic prostheses made by CAD/CAM manufacturing is lower than that of crowns mad by the conventional technique.
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Affiliation(s)
- Stéfani Becker Rodrigues
- Department of Conservative Dentistry, Dental Materials Laboratory, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Patrícia Franken
- Department of Conservative Dentistry, Dental Materials Laboratory, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Vicente Castelo Branco Leitune
- Department of Conservative Dentistry, Dental Materials Laboratory, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fabrício Mezzomo Collares
- Department of Conservative Dentistry, Dental Materials Laboratory, School of Dentistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Pan S, Guo D, Zhou Y, Jung RE, Hämmerle CHF, Mühlemann S. Time efficiency and quality of outcomes in a model‐free digital workflow using digital impression immediately after implant placement: A double‐blind self‐controlled clinical trial. Clin Oral Implants Res 2019; 30:617-626. [DOI: 10.1111/clr.13447] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Shaoxia Pan
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital StomatologyBeijing P.R. China
| | - Danni Guo
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital StomatologyBeijing P.R. China
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital StomatologyBeijing P.R. China
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
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Moustapha G, Azzam K, AlShwaimi E, Silwadi M, Ferrari M, Salameh Z. Evaluation of the fit of zirconia three-unit fixed partial dentures fabricated by different impression techniques. ACTA ACUST UNITED AC 2019; 10:e12413. [PMID: 31001919 DOI: 10.1111/jicd.12413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/01/2022]
Abstract
AIM The aim of the present study was to evaluate the marginal and internal fit of zirconium fixed partial denture using different impression techniques. METHODS A Nissin Typodont model, including maxillary central incisor and canine with missing lateral incisor, was selected for the present study. Thirty zirconium frameworks were fabricated following three impression techniques (N = 10), conventional silicone impression (group C), scanned dental impression (group S), and Trios 3 (3Shape) intraoral scanner (group T). An extra-fine milling strategy was applied. RESULTS Group T had the smallest discrepancy compared to groups C (P = 0.006) and S (P = 0.052) at the marginal level, whereas it was larger at the incisal tip. Discrepancies in group T were smaller than group C (P = 0.004) when measured at the axial walls, and smaller than group S (P = 0.045) when measured at the chamfer area for the central teeth only. Samples in group T showed a greater percentage of equally extended restorations (52.5%), while other groups were mainly underextended (group C: 63.7%, group S: 68.8%). CONCLUSION Better adaptation was achieved with the intraoral scanner group, except at the incisal tip. Conventional and scanned impressions revealed a greater percentage of underextended restorations.
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Affiliation(s)
- Ghassan Moustapha
- Department of Prosthodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Lebanon
| | | | - Emad AlShwaimi
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Munir Silwadi
- Dr Munir Silwadi Dental Centers, Abu Dhabi, United Arab Emirates
| | - Marco Ferrari
- Department of Medical Biotechnologies, Division of Restorative Dentistry and Endodontics, University of Siena, Siena, Italy
| | - Ziad Salameh
- Department of Research and Prosthodontics, Faculty of Dental Medicine, Lebanese University, Hadath, Lebanon
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Mühlemann S, Kraus RD, Hämmerle CHF, Thoma DS. Is the use of digital technologies for the fabrication of implant-supported reconstructions more efficient and/or more effective than conventional techniques: A systematic review. Clin Oral Implants Res 2019; 29 Suppl 18:184-195. [PMID: 30306680 DOI: 10.1111/clr.13300] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify clinical studies evaluating efficiency and/or effectiveness of digital technologies as compared to conventional manufacturing procedures for the fabrication of implant-supported reconstructions. MATERIALS AND METHODS A systematic search from 1990 through July 2017 was performed using the online databases Medline, Embase, and Cochrane-Central-Register-of-Controlled-Trials. Literature on efficiency and/or effectiveness during the impression session, the manufacturing process, and the delivery session were included. RESULTS In total, 12 clinical studies were included. No meta-analysis was performed due to a large heterogeneity of the study protocols. Nine publications reported on posterior single implant crowns (SIC) and three on full-arch reconstructions. Mean impression time with intraoral scanners ranged between 6.7 and 19.8 min, whereas the range for conventional impressions was 8.8 and 18.4 min. In a fully digital workflow (FD-WF) for posterior SIC, mean fabrication time ranged between 46.8 and 54.5 min (prefabricated abutment) and 68.0 min (customized abutment). In a hybrid workflow (H-WF) including a digitally customized abutment and a manual veneering, mean fabrication time ranged between 132.5 and 158.1 min. For a conventional porcelain-fused-to-metal-crown, a mean time of 189.8 min was reported. The mean time for the delivery of posterior SIC ranged between 7.3 and 7.4 min (FD-WF), 10.5 and 12.5 min (H-WF), and 15.3 min (conventional workflow, C-WF). The FD-WF for posterior SIC was more effective than the H-/C-WF. CONCLUSIONS The implementation of the studied digital technologies increased time efficiency for the laboratory fabrication of implant-supported reconstructions. For posterior SIC, the model-free fabrication, the use of prefabricated abutments, and the monolithic design was most time efficient and most effective.
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Affiliation(s)
- Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Riccardo D Kraus
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Randomized controlled clinical trial of digital and conventional workflows for the fabrication of zirconia-ceramic fixed partial dentures. Part III: Marginal and internal fit. J Prosthet Dent 2019; 121:426-431. [DOI: 10.1016/j.prosdent.2018.05.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/18/2022]
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Mahmood DJH, Braian M, Larsson C, Wennerberg A. Production tolerance of conventional and digital workflow in the manufacturing of glass ceramic crowns. Dent Mater 2019; 35:486-494. [PMID: 30686710 DOI: 10.1016/j.dental.2019.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/07/2018] [Accepted: 01/11/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To measure and compare the size of the cement gap of wax and polymer copings and final glass-ceramic crowns, produced from conventional and digital workflows, one additive and one subtractive. METHODS Thirty wax copings were made by conventional manual layering technique and modeling wax on stone models with spacer varnish simulating a cement spacer. The wax copings were embedded and press-cast in lithium disilicate glass ceramic. Thirty wax copings were produced by milling from a wax blank, i.e. subtractive manufacturing, and thirty polymer burn-out copings were produced by stereolithography, i.e. additive manufacturing. These copings were embedded and press-cast in lithium disilicate glass ceramic in the same manner as the conventional group. The fit of the wax/polymer copings and subsequent crowns was checked using an impression replica method. Mean values for cement gap for marginal, axial, and occlusal areas were calculated and differences were analyzed using Student's t-test. RESULTS There were significant differences in mean values for accuracy/production tolerance among different manufacturing techniques for both production stages: wax and polymer copings and final pressed glass-ceramic crowns. In general, crowns produced from a digital additive workflow showed smaller mean cement gaps than crowns produced from a conventional workflow or a digital subtractive workflow. Additive polymer copings showed significantly smaller cement gaps than milled wax copings (p≤.001) and conventional wax copings (p≤.001) in the axial area. In the occlusal area, both additive polymer copings and conventional wax copings showed significantly smaller cement gaps than milled wax copings (p=.002 and p≤.001 respectively). Crowns produced from conventional manual build-up wax copings showed significantly larger mean cement gaps than crowns produced from milled wax and additively manufactured polymer copings in the marginal and axial areas (p≤.001). Among the crowns with smaller cement gaps, crowns produced from additively manufactured polymer copings showed significantly smaller mean cement gaps than crowns produced from milled wax in the marginal and axial areas (p≤.001). In the occlusal areas, the differences in mean cement gaps were only statistically significant between crowns produced from conventional manual build-up wax copings and crowns produced from milled wax where the latter ones showed smaller mean cement gaps (p=.025). SIGNIFICANCE The present study suggests that an additive manufacturing technique produces smaller mean cement gaps in glass-ceramic crowns than a conventional or subtractive manufacturing technique.
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Affiliation(s)
- Deyar Jallal Hadi Mahmood
- Department of Prosthetic Dentistry, Faculty of Odontology, Malmö University, Malmö, SE-205 06, Sweden.
| | - Michael Braian
- Department of Prosthetic Dentistry, Faculty of Odontology, Malmö University, Malmö, SE-205 06, Sweden.
| | - Christel Larsson
- Department of Materials Science and Technology, Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - Ann Wennerberg
- Institution of Odontology, Göteborg university, Göteborg, Sweden.
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Randomized controlled clinical trial of digital and conventional workflows for the fabrication of zirconia-ceramic fixed partial dentures. Part I: Time efficiency of complete-arch digital scans versus conventional impressions. J Prosthet Dent 2019; 121:69-75. [DOI: 10.1016/j.prosdent.2018.04.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 11/15/2022]
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Praça L, Pekam FC, Rego RO, Radermacher K, Wolfart S, Marotti J. Accuracy of single crowns fabricated from ultrasound digital impressions. Dent Mater 2018; 34:e280-e288. [PMID: 30268677 DOI: 10.1016/j.dental.2018.08.301] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This in vitro study aimed to evaluate marginal and internal fit of single crowns produced from high-frequency ultrasound based digital impressions of teeth prepared with finish lines covered by porcine gingiva, in comparison with those obtained by optical scanners with uncovered finish lines. METHODS Ten human teeth were prepared and forty zirconia crowns were fabricated from STL-datasets obtained from four dental scanners (n=10): extraoral CS2 (Straumann), intraoral Lava COS (3M), intraoral Trios (3Shape) and extraoral ultrasound scanner. The accuracy of the crowns was compared evaluating marginal and internal fit by means of the replica technique with measurements in four areas; P1: occlusal surface; P2: transition between occlusal and axial surfaces; P3: middle of axial wall; and P4: marginal gap. Restoration margins were classified according to their mismatch as regular, underextended or overextended. Kruskal-Wallis one-way ANOVA and Mann-Whitney U test were used to evaluate the differences between groups at p<0.05. RESULTS The median value of marginal gap (P4) for Ultrasound (113.87μm) differed statistically from that of CS2 (39.74μm), Lava COS (41.98μm) and Trios (42.07μm). There were no statistical differences between ultrasound and Lava COS for internal misfit (P1-P3), however there were statistical differences when compared with the other two scanners (Trios and CS2) at P1 and P2. SIGNIFICANCE The ultrasound scanner was able to make digital impressions of prepared teeth through porcine gingiva (P4), however with less accuracy of fit than that of conventional optical scanners without coverage of the finish lines. Where no gingiva was available (P1-P3), the ultrasound accuracy of fit was similar to that of at least one optical scanner (Lava COS).
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Affiliation(s)
- Luciano Praça
- Department of Prosthodontics and Biomaterials, Medical School RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; School of Dentistry, University of Fortaleza, Av. Washington Soares, 1321, 60.811-905 Fortaleza, Brazil
| | - Fabrice Chuembou Pekam
- Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrasse 20, 52074 Aachen, Germany
| | - Rodrigo Otavio Rego
- Department of Dentistry, School of Dentistry at Sobral, Federal University of Ceará, Rua Estanislau Frota S/N, 62010-560 Sobral, Brazil
| | - Klaus Radermacher
- Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrasse 20, 52074 Aachen, Germany
| | - Stefan Wolfart
- Department of Prosthodontics and Biomaterials, Medical School RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Juliana Marotti
- Department of Prosthodontics and Biomaterials, Medical School RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Mühlemann S, Benic GI, Fehmer V, Hämmerle CHF, Sailer I. Randomized controlled clinical trial of digital and conventional workflows for the fabrication of zirconia-ceramic posterior fixed partial dentures. Part II: Time efficiency of CAD-CAM versus conventional laboratory procedures. J Prosthet Dent 2018; 121:252-257. [PMID: 30037692 DOI: 10.1016/j.prosdent.2018.04.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 10/28/2022]
Abstract
STATEMENT OF PROBLEM Clinical trials are needed to evaluate the digital and conventional fabrication technology for providing fixed partial dentures (FPDs). PURPOSE The purpose of the second part of this clinical study was to compare the laboratory production time for tooth-supported, 3-unit FPDs by means of computer-aided design and computer-aided manufacturing (CAD-CAM) systems and a conventional workflow. In addition, the quality of the 3-unit framework of each treatment group was evaluated clinically. MATERIAL AND METHODS For each of 10 participants, a 3-unit FPD was fabricated. Zirconia was used as the framework material in the CAD-CAM systems and included Lava C.O.S. CAD software (3M) and centralized CAM (group L); CARES CAD software (Institut Straumann AG) and centralized CAM (group iT); and CEREC Connect CAD software (Dentsply Sirona) and centralized CAM (group C). The noble metal framework in the conventional workflow (group K) was fabricated by means of the traditional lost-wax technique. All frameworks were evaluated clinically before veneering. The time for the fabrication of the cast, the 3-unit framework, and the veneering process was recorded. In addition, chairside time during the clinical appointment for the evaluation of the framework was recorded. The paired Wilcoxon test together with appropriate Bonferroni correction was applied to detect differences among treatment groups (α=.05). RESULTS The total effective working time (mean ±standard deviation) for the dental technician was 220 ±29 minutes in group L, 217 ±23 minutes in group iT, 262 ±22 minutes in group C, and 370 ±34 minutes in group K. The dental technician spent significantly more time in the conventional workflow than in the digital workflow, independent of the CAD-CAM systems used (P<.001). CONCLUSIONS Irrespective of the CAD-CAM system, the overall laboratory time for the dental technician was significantly less for a digital workflow than for the conventional workflow.
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Affiliation(s)
- Sven Mühlemann
- Senior Teaching and Research Assistant, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
| | - Goran I Benic
- Senior Teaching and Research Assistant, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Vincent Fehmer
- Master Dental Technician, Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Christoph H F Hämmerle
- Professor, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Irena Sailer
- Professor, Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
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Digital versus Analog Procedures for the Prosthetic Restoration of Single Implants: A Randomized Controlled Trial with 1 Year of Follow-Up. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5325032. [PMID: 30112398 PMCID: PMC6077568 DOI: 10.1155/2018/5325032] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/03/2018] [Indexed: 11/17/2022]
Abstract
Aim To compare the outcome of digital versus analog procedures for the restoration of single implants. Methods Over a two-year period (2014-2016), all patients who had been treated in a dental center with a single implant were randomly assigned to receive either a monolithic zirconia crown, fabricated with digital workflow (test group), or a metal-ceramic crown, fabricated with analog workflow (control group). All patients were followed for 1 year after the delivery of the final crown. The outcomes were success, complications, peri-implant marginal bone loss (PIMBL), patient satisfaction, and time and cost of the treatment. Results 50 patients (22 males, 28 females; mean age 52.6±13.4 years) were randomly assigned to one of the groups (25 per group). Both workflows showed high success (92%) and low complication rate (8%). No significant differences were found in the mean PIMBL between test (0.39±0.29mm) and control (0.54±0.32mm) groups. Patients preferred digital impressions. Taking the impression took half the time in the test group (20±5min) than in the control (50±7min) group. When calculating active working time, workflow in the test group was more time-efficient than in the control group, for provisional (70±15min versus 340±37min) and final crowns (29±9min versus 260±26min). The digital procedure presented lower costs than the analog (€277.3 versus €392.2). Conclusions No significant clinical or radiographic differences were found between digital and analog procedures; however, the digital workflow was preferred by patients; it reduced active treatment time and costs. The present study is registered in the ISRCTN (http://www.isrctn.com/ISRCTN36259164) with number 36259164.
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Mühlemann S, Bernini JM, Sener B, Hämmerle CH, Özcan M. Effect of Aging on Stained Monolithic Resin-Ceramic CAD/CAM Materials: Quantitative and Qualitative Analysis of Surface Roughness. J Prosthodont 2018; 28:e563-e571. [PMID: 29999570 DOI: 10.1111/jopr.12949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this in vitro study was to measure the effect of staining and artificial aging on the surface roughness of commercially available resin-ceramic computer-aided design and computer-aided manufacturing (CAD/CAM) materials both quantitatively and qualitatively and to compare it to feldspathic material. MATERIALS AND METHODS Test specimens (n = 15 per material) were prepared of CAD/CAM ingots from a resin nanoceramic (Lava Ultimate, LVU), a polymer-infiltrated ceramic (Vita Enamic, ENA), and a resin nanoceramic (Cerasmart, CER). In the staining protocol, test specimens were (i) roughened in a standardized manner and (ii) stained with the manufacturer's recommended staining kit by means of photo-polymerization (Bluephase Polywave). The control specimens were prepared out of a feldspathic ceramic (Vita Mark II,VM2) and stained in a ceramic furnace. As negative control of each group, 15 specimens were prepared and polished in a standardized manner. Surface roughness (Ra) was measured after finishing procedures and after simulation of clinical service up to 5 years by means of toothbrushing. After each year of aging, one specimen per group was randomly selected for scanning electron microscopy (SEM) analysis. Kruskal-Wallis test and paired post-hoc test were applied to detect differences between treatment groups (alpha = 0.05). RESULTS The mean roughness measurements of the stained CAD/CAM materials were 0.14 ± 0.04 μm (ENA), 0.15 ± 0.03 μm (LVU), 0.22 ± 0.03 μm (VM2), and 0.26 ± 0.12 μm (CER). In the polished CAD/CAM materials the measurements were 0.01 ± 0.01 μm (CER), 0.02 ± 0.01 μm (LVU), 0.02 ± 0.00 μm (VM2), and 0.03 ± 0.01μm (ENA). Irrespective of the restoration material, the applied staining protocol resulted in a higher surface roughness compared to the polished specimens (p < 0.001). After 5 years of simulated aging the mean surface roughness in the stained CAD/CAM materials were 0.22 ± 0.03 μm (VM2), 0.24 ± 0.09 μm (ENA), 0.25 ± 0.06 μm (CER), and 0.37 ± 0.09 μm (LVU). Aging had a significant effect on surface roughness in groups ENA and LVU (p < 0.001). SEM analysis showed that the staining layer on resin-ceramic CAD/CAM materials was partially removed over time. CONCLUSIONS The applied staining protocol significantly increased surface roughness of CAD/CAM materials. Instability of the staining layer on resin-ceramic CAD/CAM materials could be anticipated over time as a consequence of toothbrushing, whereas feldspathic ceramic did not suffer from such aging effect.
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Affiliation(s)
- Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Joëlle M Bernini
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Beatrice Sener
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph Hf Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Extending the service life of existing dental restorations with esthetic and functional limitations. J Prosthet Dent 2018; 119:893-896. [DOI: 10.1016/j.prosdent.2017.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022]
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Zeltner M, Sailer I, Mühlemann S, Özcan M, Hämmerle CHF, Benic GI. Randomized controlled within-subject evaluation of digital and conventional workflows for the fabrication of lithium disilicate single crowns. Part III: marginal and internal fit. J Prosthet Dent 2016; 117:354-362. [PMID: 27677220 DOI: 10.1016/j.prosdent.2016.04.028] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 10/20/2022]
Abstract
STATEMENT OF PROBLEM Trials comparing the overall performance of digital with that of conventional workflows in restorative dentistry are needed. PURPOSE The purpose of the third part of a series of investigations was to test whether the marginal and internal fit of monolithic crowns fabricated with fully digital workflows differed from that of crowns fabricated with the conventional workflow. MATERIAL AND METHODS In each of 10 participants, 5 monolithic lithium disilicate crowns were fabricated for the same abutment tooth according to a randomly generated sequence. Digital workflows were applied for the fabrication of 4 crowns using the Lava, iTero, Cerec inLab, and Cerec infinident systems. The conventional workflow included a polyvinyl siloxane impression, manual waxing, and heat-press technique. The discrepancy between the crown and the tooth was registered using the replica technique with polyvinyl siloxane material. The dimensions of the marginal discrepancy (Discrepancymarginal) and the internal discrepancy in 4 different regions of interest (Discrepancyshoulder, Discrepancyaxial, Discrepancycusp, and Discrepancyocclusal) were assessed using light microscopy. Post hoc Student t test with Bonferroni correction was applied to detect differences (α=.05). RESULTS Discrepancymarginal was 83.6 ±51.1 μm for the Cerec infinident, 90.4 ±66.1 μm for the conventional, 94.3 ±58.3 μm for the Lava, 127.8 ±58.3 μm for the iTero, and 141.5 ±106.2 μm for the Cerec inLab workflow. The differences between the treatment modalities were not statistically significant (P>.05). Discrepancyshoulder was 82.2 ±42.4 μm for the Cerec infinident, 97.2 ±63.8 μm for the conventional, 103.4 ±52.0 μm for the Lava, 133.5 ±73.0 μm for the iTero, and 140.0 ±86.6 μm for the Cerec inLab workflow. Only the differences between the Cerec infinident and the Cerec inLab were statistically significant (P=.036). The conventionally fabricated crowns revealed significantly lower values in Discrepancycusp and Discrepancyocclusal than all the crowns fabricated with digital workflows (P<.05). CONCLUSIONS In terms of marginal crown fit, no significant differences were found between the conventional and digital workflows for the fabrication of monolithic lithium disilicate crowns. In the occlusal regions, the conventionally manufactured crowns revealed better fit than the digitally fabricated crowns. Chairside milling resulted in less favorable crown fit than centralized milling production.
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Affiliation(s)
- Marco Zeltner
- Postgraduate student, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Irena Sailer
- Professor, Division of Fixed Prosthodontics and Biomaterials, University Center of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Sven Mühlemann
- Senior Teaching and Research Assistant, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Mutlu Özcan
- Professor, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Professor, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Goran I Benic
- Senior Teaching and Research Assistant, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
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