Evaluation of the marginal fit of CAD-CAM zirconia copings: Comparison of 2D and 3D measurement methods

CAD-CAM and heat-press: Comparison of internal and marginal fit of lithium disilicate copings

The aim of this in vitro study is to compare the performance of digital and conventional methods in the manufacture of single copings in terms of the internal and marginal fit. Twenty-four prefabricated titanium Cone Morse Exact abutments of the lateral anatomical type were used to manufacture 24 lithium disilicate copings in the CAD-CAM Ceramill (n = 12) and heat-press (n = 12) systems. The copings were cemented using a self-adhesive resin cement (RelyX U-200; 3M ESPE) and then cut vertically. The cement line was photographed using an optical microscope at ×100 and ×200 magnification and then the internal and marginal regions were measured. The mean values of fits, for the CAD-CAM and heat-press techniques, respectively, were (μm): angular regions, 81.8 and 75.3; linear regions, 63.1 and 60.1; incisal regions, 171.1 and 114.7; marginal discrepancy, 74.1 and 75.2; and absolute marginal discrepancy, 99.5 and 96.2. MANOVA test showed that there is an effect of the techniques on the regions (p < .05). The effects of laboratories and the interaction between laboratories and techniques on the regions were not statistically significant (p > .05). The techniques evaluated presented clinically acceptable results for the marginal fit. However, the conventional method performed better for the internal fit. RESEARCH HIGHLIGHTS: Scientific evidence regarding the methods of making prosthesis can help the dental professional in decision-making. Digital and conventional methods is both good in the manufacture of single copings in terms of the internal and marginal fit.

Does the choice of the measuring technique affect the comparison of fit between zirconia and cobalt-chromium prostheses?

AIMS

The objectives of the study were to compare the adaptation of presintered zirconia and cobalt- chromium prostheses using microcomputed tomography (μCT), scanning electron microscopy (SEM), and stereomicroscope (SM).

MATERIALS AND METHODS

Twenty-four fixed dental prostheses (FDPs) were fabricated on metal abutments, duplicated from maxillary first premolar and first molar prepared on a typodont model. Teeth were reduced to obtain chamfer of 1.2 mm and reduction occlusaly of 2 mm occlusal. Scanning of the abutments was done with random assignment to two groups receiving the FDPs made from soft-milled Co-Cr (n = 12) and zirconia (n = 12). Marginal and internal gaps were assessed using three evaluation techniques (X-ray microcomputer tomography, SEM, and stereomicroscopy).

STATISTICAL ANALYSIS USED

Comparison of the results was made using Levene and analysis of variance tests (α =0.05).

RESULTS

Irrespective of the material tested, statistical differences were found between the measuring techniques (P = 0.001 overall); the obtained mean gaps were for CT scan (92.60 ± 13.31), for SEM (101.92 ± 23.03), and for SM (113.44 ± 14.68): the multiple comparisons between techniques found a significant difference between CT and SM (P < 0.001), and SEM and SM (P = 0.025). When materials were compared within each measuring technique, Co-Cr showed lower values compared to zirconia in SEM (P < 0.001) and Stereo (P = 0.049); similar results were found in CT.

CONCLUSIONS

Results values differed with the chosen measuring technique. Co-Cr prostheses had a better fit than zirconia prostheses in SEM and Stereo. µCT showed comparable results to SEM, smaller than SM results.

SEM Evaluation of the Marginal Gap of Zirconia-Reinforced Lithium Silicate Full Crowns and the Effect of Post Crystallization: An In Vitro Study

BACKGROUND

This study compared the influence of crystallization on marginal gap adaptation by using computer-aided design and manufacturing (CAD-CAM) for producing monolithic zirconia-reinforced lithium silicate (ZLS) ceramic crowns.

METHODS

A total of 25 plastic teeth were scanned using a Primescan intra-oral scanner (IOS), and ZLS crowns were ground. For each unit (abutment and crown), the marginal gap was evaluated pre crystallization and post crystallization at four regions of interest through the use of a scanning electron microscope (SEM). To compare the marginal gap between the two groups, a Kolmogorov-Smirnov test performed on the study variables indicated a normal distribution (p > 0.05) followed by paired samples T-tests (α = 0.0005).

RESULTS

After crystallization, there were significantly higher circumferential marginal gaps (CMGs) for all four surfaces (distal (p = 0.0005), mesial (p = 0.0005), palatal (p = 0.0005), and buccal (p = 0.0005)). The total mean marginal gap (MMG) revealed a significantly higher result for the post-crystallization group (79.82 ± 7.86 μm) compared to the pre-crystallization group (24.25 ± 5.49 μm).

CONCLUSIONS

The post-crystallization group showed a significantly higher marginal gap compared to the pre-crystallization group in all parameters, but both groups were in the clinically accepted threshold (<120 microns). In terms of the marginal gap, it is arguable whether to carry out post-crystallization for CELTRA® DUO crowns and achieve better mechanical properties but significantly increase the marginal gap.

Effect of industrial scanner and framework material interaction on the marginal gaps of CAD-CAM complete arch implant frameworks

STATEMENT OF PROBLEM

Structured-light and computed tomography industrial scanners have been used as reference scanners to measure marginal gaps between implants and superstructures. However, the effect of framework material on the scanners' ability to detect gaps and on precision has not yet been evaluated.

PURPOSE

The purpose of this in vitro study was to investigate the interaction between the industrial scanner and framework material on measured marginal gaps of implant-supported fixed complete arch frameworks made from titanium and polymethylmethacrylate and on the precision of scans.

MATERIAL AND METHODS

A completely edentulous maxillary model with 4 implants and multiunit abutments at the first molar and canine sites was digitized by using a laboratory scanner. Implant-supported frameworks were milled from titanium and polymethylmethacrylate (n=5). Each framework was secured on the left molar site abutment. The marginal gaps between the frameworks and abutment sites without a screw were measured by using an industrial structured-light scanner and an industrial computed tomography scanner. The effect of the scanner, the framework material, and their interaction on measured gaps was analyzed by applying linear regressions and weighted least square methods. The F-statistics was used with Bonferroni corrections for precision analysis (α=.05).

RESULTS

No significant effect of scanner, material, or their interaction was found on the marginal gaps at the canine sites. The titanium framework gaps detected by using the computed tomography scanner were greater than those detected by using the structured-light scanner at the right molar site (estimated difference in means=0.054 mm; P=.003) and overall (estimated difference in means=0.023 mm; P=.033). The structured-light scanner's precision was higher than that of the computed tomography scanner when titanium frameworks were scanned (P=.001). The computed tomography scanner's precision was higher when scanning polymethylmethacrylate frameworks than when scanning titanium frameworks (P=.03).

CONCLUSIONS

Framework material and industrial scanner interaction affected the measured gaps. The computed tomography scanner detected greater marginal gaps with low precision when scanning titanium frameworks than the structured-light scanner. The sample size, the use of only 2 types of materials, and a laboratory scanner to obtain the computer-aided design file should be considered when interpreting the results.

Evaluation of marginal and internal fit of single crowns manufactured with an analog workflow and three CAD-CAM systems: A prospective clinical study

PURPOSE

This prospective clinical study evaluated and compared the marginal and internal fit of crowns fabricated with an analog workflow and three different computer-aided design and computer-aided manufacturing (CAD-CAM) systems.

MATERIALS AND METHODS

Twenty-five participants in need of a single complete-coverage molar or premolar crown were recruited in the study. Twenty-two completed the study, and three participants dropped out. Teeth were prepared according to a standardized protocol by one operator. For each participant, one final impression was made with polyether material (PP) and three intraoral scanners: CEREC Omnicam (C), Planmeca Planscan (PM), and True Definition (TR). For the PP group, crowns were fabricated with a pressable lithium disilicate ceramic, whereas for the other three groups (C, PM, and TR), crowns were designed and milled with dedicated CAD-CAM systems and materials. Marginal (vertical and horizontal) and internal discrepancies between the crowns and tooth preparation were measured at various locations with digital superimposition software. Data was analyzed for normality with Kolmogorov-Smirnov and Shapiro-Wilk tests and then compared with one-way ANOVA and Kruskal-Wallis tests.

RESULTS

Mean vertical marginal gap values were 92.18 ± 141.41 μm (PP), 150.12 ± 138.06 μm (C), 129.07 ± 109.96 μm (PM), and 135.09 ± 112.03 μm (TR). PP group had statistically significantly smaller vertical marginal discrepancy (p = 0.001) than all other groups, whereas no significant difference was detected among the three CAD-CAM systems (C, PM, and TR). Horizontal marginal discrepancies were 104.93 ± 111.96 μm (PP), 89.49 ± 119.66 μm (C), 113.36 ± 128.49 μm (PM), and 136.39 ± 142.52 μm (TR). A significant difference was detected only between C and TR (p < 0.0001). Values for the internal fit were 128.40 ± 49.31μm (PP), 190.70 ± 69.79μm (C), 146.30 ± 57.70 μm (PM), and 168.20 ± 86.67 μm (TR). The PP group had a statistically significant smaller internal discrepancy than C (p < 0.0001) and TR groups (p = 0.001), whereas no significant difference was found compared to the PM group.

CONCLUSION

Posterior crowns fabricated with CAD-CAM systems showed vertical margin discrepancy greater than 120 μm. Only crowns fabricated with the conventional methodology had vertical margins below 100 μm. Horizontal marginal discrepancy was different among all groups, and only CEREC CAD-CAM was below 100 μm. Internal discrepancy was less for crowns fabricated with an analog workflow.

Additively and subtractively manufactured implant-supported fixed dental prostheses: A systematic review

AIM

To compare and report on the performance of implant-supported fixed dental prostheses (iFDPs) fabricated using additive (AM) or subtractive (SM) manufacturing.

METHODS

An electronic search was conducted (Medline, Embase, Cochrane Central, Epistemonikos, clinical trials registries) with a focused PICO question: In partially edentulous patients with missing single (or multiple) teeth undergoing dental implant therapy (P), do AM iFDPs (I) compared to SM iFDPs (C) result in improved clinical performance (O)? Included were studies comparing AM to SM iFDPs (randomized clinical trials, prospective/retrospective clinical studies, case series, in vitro studies).

RESULTS

Of 2'184 citations, no clinical study met the inclusion criteria, whereas six in vitro studies proved to be eligible. Due to the lack of clinical studies and considerable heterogeneity across the studies, no meta-analysis could be performed. AM iFDPs were made of zirconia and polymers. For SM iFDPs, zirconia, lithium disilicate, resin-modified ceramics and different types of polymer-based materials were used. Performance was evaluated by assessing marginal and internal discrepancies and mechanical properties (fracture loads, bending moments). Three of the included studies examined the marginal and internal discrepancies of interim or definitive iFDPs, while four examined mechanical properties. Based on marginal and internal discrepancies as well as the mechanical properties of AM and SM iFDPs, the studies revealed inconclusive results.

CONCLUSION

Despite the development of AM and the comprehensive search, there is very limited data available on the performance of AM iFDPs and their comparison to SM techniques. Therefore, the clinical performance of iFDPs by AM remains to be elucidated.

Accuracy and margin quality of advanced 3D-printed monolithic zirconia crowns

STATEMENT OF PROBLEM

Nanoparticle jetting (NPJ) is a novel ceramic 3D-printing technology with high printing accuracy. However, studies reporting the accuracy of zirconia crowns manufactured by NPJ and comparing them with conventional zirconia crowns are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate and compare the trueness, crown fit, and margin quality of monolithic zirconia crowns manufactured by NPJ with those milled by a computer numerical control system.

MATERIAL AND METHODS

A gypsum left mandibular first molar was prepared and scanned with an intraoral scanner (TRIOS 4). Three types of monolithic crowns were manufactured through 3D printing and subtractive manufacturing (SM): NPJ (3D printing), VITA (milling), UPCERA (milling). The crowns were scanned, and the dimensional deviation (trueness) was evaluated and compared by using a software program. The triple scan method was used to measure crown fit and uniform index through precise alignment in the software program, and margin quality was also observed with an optical microscope. The data were analyzed with 1-way analysis of variance and the Tukey post hoc test (α=.05).

RESULTS

The NPJ group reported better trueness of all crown and axial surfaces compared with the other SM group (P<.001), but marginal trueness (P=.601), intaglio surface (P=.596), and occlusal surface (P=.641) were statistically similar compared with the Vita milled group. All 3 groups reported clinically acceptable crown fit and uniformity with statistically similar values (P>.05). The NPJ group had more crowns judged to have flawless margin quality compared with the milled groups.

CONCLUSIONS

All 3 manufacturing methods can fabricate zirconia crowns with a clinically acceptable crown fit. The NPJ system could be used to manufacture monolithic zirconia crowns with better margin quality and proximal surface trueness than milled crowns.

Marginal fit of monolithic versus layered zirconia crowns assessed with 2 marginal gap methods

STATEMENT OF PROBLEM

Zirconia can be used either monolithically or veneered with porcelain. However, whether veneering zirconia affects marginal fit is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal fit of the monolithic and layered zirconia prostheses using 2 different assessment methods.

MATERIAL AND METHODS

An ideal complete crown with a chamfer finish line was prepared on an extracted maxillary central incisor. Two prosthesis designs, a framework and a monolithic design, and 2 marginal fit evaluation methods, the silicone replica and the triple scanning techniques, were used. In the first group, 10 crowns were fabricated with the framework design followed by porcelain veneering, and 10 crowns were fabricated monolithically in the second group. The marginal gap in each group was evaluated with both the silicone replica and triple scan methods. Data were statistically analyzed with a 2-way repeated measures ANOVA (α=.05).

RESULTS

A significant difference was found in the mean marginal gap by design type (P=.003), with the monolithic prostheses having lower mean marginal gaps (31.0 and 84.0 µm). However, both groups showed clinically acceptable marginal fit. No significant difference was found between the assessment methods (P=.092).

CONCLUSIONS

Monolithic zirconia crowns had a better marginal fit than veneered zirconia frameworks. Both the replica and triple scan techniques for marginal gap assessment yielded similar results.

Effect of cement space settings on the marginal and internal fit of 3D-printed definitive resin crowns

STATEMENT OF PROBLEM

The cement gap setting affects the marginal and internal fits depending on the crown material and manufacturing method (subtractive or additive manufacturing). However, information on the effects of cement space settings in the computer-aided design (CAD) software program, which is used to aid the manufacturing with 3-dimensional (3D) printing-type resin material, is lacking, and recommendations for optimal marginal and internal fit are needed.

PURPOSE

The purpose of this in vitro study was to evaluate how cement gap settings affect the marginal and internal fit of a 3D-printed definitive resin crown.

MATERIAL AND METHODS

After scanning a prepared typodont left maxillary first molar, a crown was designed with cement spaces of 35, 50, 70, and 100 μm by using a CAD software program. A total of 14 specimens per group were 3D printed from definitive 3D-printing resin. By using the replica technique, the intaglio surface of the crown was duplicated, and the duplicated specimen was sectioned in the buccolingual and mesiodistal directions. Statistical analyses were performed using the Kruskal-Wallis and the Mann-Whitney post hoc tests (α=.05).

RESULTS

Although the median values of the marginal gaps were within the clinically acceptable limit (<120 μm) for all the groups, the smallest marginal gaps were obtained with the 70-μm setting. For the axial gaps, there was no observed difference in the 35-, 50-, and 70-μm groups, and the 100-μm group showed the largest gap. The smallest axio-occlusal and occlusal gaps were obtained with the 70-μm setting.

CONCLUSIONS

Based on the findings of this in vitro study, a 70-μm cement gap setting is recommended for optimal marginal and internal fit of 3D-printed resin crowns.

Comparative evaluation of internal fit and marginal gap of endocrowns using lithium disilicate and polyether ether ketone materials - an in vitro study

BACKGROUND

The aim of the study was to investigate the effect of material and occlusal preparation design on the internal fit and marginal gap of endocrowns made of Polyether ether ketone (PEEK) and lithium disilicate.

METHODS

32 endocrowns were fabricated on prepared mandibular molars and divided into two groups (n = 16) according to the material. Group L: lithium disilicate and Group P: PEEK. Each group was further subdivided into two subgroups (n = 8) according to the occlusal preparation design: full occlusal coverage (LF and PF) and partial occlusal coverage (LP and PP). Samples were analyzed using microcomputed tomography (µCT) with a voxel size of 6 μm to evaluate internal fit, and an optical microscope was used to evaluate the marginal gap. Data were collected, tabulated, and statistically analyzed. Numerical data were described as mean and standard deviation and compared using the ANOVA test. The level of significance was set at α P ≤ 0.05.

RESULTS

All groups' internal fit and marginal gaps values were within the acceptable clinical range. However, the lithium disilicates group recorded statistically significantly higher mean internal gap values than the PEEK groups. Regardless of the material, the difference between the two occlusal designs was not statistically significant in both internal fit and marginal gap records.

CONCLUSION

Within the limitations of this study, PEEK endocrown restorations revealed better internal fit and marginal gap than lithium disilicate endocrown restorations. The marginal and internal fit of both lithium disilicate and PEEK endocrown restorations were within the clinically acceptable range. The occlusal preparation design had no influence on the internal fit and marginal gap of the endocrown restoration.

Internal Adaptation and Marginal Accuracy of Two Different Techniques-based Poly (ether ether ketone) Single Crowns: An In Vitro Study

PURPOSE

The goal of this study was to evaluate how different fabrication techniques affected the marginal accuracy and internal adaptability of poly (ether ether ketone) (PEEK) molar single crowns.

MATERIALS AND METHODS

Twenty PEEK crowns were constructed using two different fabrication techniques, and they were divided into two main groups (PEEK-CAD and PEEK-pressed). PEEK-CAD crowns were numbered from 1 to 10. PEEK-pressed crowns were numbered from 11 to 20. Each group had 10 PEEK crowns, and both were constructed over a master die. For internal fit measurements, silicone replica bodies were built and cut into two halves buccolingually. Marginal accuracy was measured using three evenly spaced landmarks along the specimen's cervical circumference on each surface using a Leica L2 APO* microscope.

RESULTS

In terms of marginal accuracy, the Press group had a statistically significant greater mean marginal gap value than the computer aided-designing (CAD) group. While in terms of internal fit, there was no statistically significant difference in internal fit between the CAD and Press groups. At a significance level of two-tailed p-value = 0.21 (p > 0.05).

CONCLUSION

PEEK-CAD crowns demonstrated higher marginal accuracy and nearly similar internal fit when compared to PEEK-pressed crowns.

CLINICAL SIGNIFICANCE

PEEK material could be used as a substitute for zirconia for a full coverage posterior restoration.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

Evaluation of the marginal fit of finish line designs of novel CAD/CAM restoration materials

Aim: The purpose of this study is to compare the marginal fit of crowns manufactured using different CAD/CAM materials on 2 different types of finish line design. Material and method: Tooth preparations were made by creating 2 different finish lines (rounded shoulder, chamfer) on an acrylic mandibular second premolar model. Impressions were taken on each preparation using polyvinylsiloxane impression material, and blocks with three different compositions including lithium disilicate (LDS), zirconia-reinforced lithium silicate (ZLS), and monolithic zirconia (MZ) (UP.CAD, Celtra Duo, and VITA YZ HT) were produced using a CAD/CAM (computer-aided-design and computer-aided-manufacturing) milling device (VHF R5) (n=10). The marginal gap values of the crown restorations were measured by the same operator using a stereomicroscope (LEICA DVM6). Histogram plots and the Kolmogorov-Smirnov test were used to test the normality of the distributions of the variables. The non-normally distributed (nonparametric) variables were compared using the Mann-Whitney U test for two groups and the Kruskal-Wallis test for more than two groups. Results: The marginal gap values were compared between finish line designs separately for each material. Accordingly, the marginal gap values of the rounded shoulder finish line were smaller than those of the chamfer finish line in all materials. The marginal gap values were also compared among the materials separately for each finish line type. Accordingly, the marginal gap values of the VITA YZ HT material were smaller than those of the Celtra Duo (ZLS) and UP.CAD (LDS) materials for both finish line designs. There was no significant difference between Celtra Duo and UP.CAD. Conclusion: The finish line design is a factor that affects marginal fit. Monolithic zirconia is more appropriate for clinical use as it shows a better marginal fit compared to LDS and ZLS.

Accuracy of Additively Manufactured and Milled Interim 3-Unit Fixed Dental Prostheses

PURPOSE

To investigate the accuracy of additive manufacturing (AM) by means of internal fit of fixed dental prostheses (FDPs) fabricated with two AM technologies using different resins and printing modes (validated vs non-validated) compared to milling and direct manual methods.

MATERIAL AND METHODS

Sixty 3-unit interim FDPs replacing the first mandibular molar were divided into 6 groups (n = 10): manual (Protemp 4), milled (Telio-CAD), and AM groups were subdivided based on AM technology (direct light processing (Rapidshape P30 [RS]) and stereolithography (FormLabs 2 [FL])) and the polymer type (P-Pro-C&B [St] and SHERAprint-cb [Sh]) (RS-St, RS-Sh, FL-St, FL-Sh). Validated (RS-Sh and RS-St) or non-validated (FL-St and FL-Sh) modes were adopted for AM. The specimens were scanned to 3D align (GOM inspect) according to the triple scan method. The internal space between the FDPs and preparation surfaces in four sites (marginal, axial, occlusal, and total) was measured using equidistant surface points (GOM Inspect). Statistical analysis was done using Kruskal Wallis and Dunn post-hoc tests. (α = .05).

RESULTS

One AM group (FL-Sh) and milling exhibited better adaptation compared to manual and RS-St at molar site (P<.05). FDPs with St resin (FL-St and RS-St) displayed bigger marginal space than milled, FL-Sh, and RS-Sh. The non-validated printing mode showed better mean space results (P<.05) with higher predictability and repeatability (P<.001).

CONCLUSIONS

The AM interim FDPs tested provided valid alternatives to the milled ones in regard to their accuracy results. The printing mode, resin, and the AM technology used significantly influenced the manufacturing accuracy of interim FDPs, particularly at the marginal area. The non-validated printing mode with lower-cost 3D printers is a promising solution for clinical applications. This article is protected by copyright. All rights reserved.

Effects of porcelain veneering methods on conformity of the marginal and internal fit of three-unit zirconia framework

The purpose of this study is to investigate the effects of porcelain veneering methods on the marginal and internal fit of a three-unit zirconia framework. A zirconia master model, in which the lower-left second premolar and the second left molar were used as the abutment, was obtained using an intraoral scanner. Based on the data, three-unit zirconia frameworks for fabricating all-ceramic bridges were designed and milled (FW group). Two types of all-ceramic bridge were fabricated by veneering porcelain onto these frameworks using the press-over technique (P group) and the layering technique (L group). The replica technique was used to measure the gap size between the abutments and the bridges. Measurements were taken in the marginal opening area (MO), chamfer area (CH), axial area (AX), and occlusal area (OC). Statistical analysis was performed using the Mann-Whitney U-test. There was no significant difference in MO and CH between the P and L groups. However, in AX, the L group had a significantly larger gap size than that of the P group (p = 0.003). In addition, compared with the FW group, the P group showed a significantly larger gap size in MO (p < 0.000), CH (p = 0.008), and OC (p < 0.000). These results indicate that the gap size increased after porcelain veneering using the press-over and layering techniques. In addition, the all-ceramic bridges fabricated using the press-over and layering techniques had approximately equal gap sizes in MO.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

A comparative study between replica and cementation techniques in the evaluation of internal and marginal misfits of single crowns

STATEMENT OF PROBLEM

Systematic reviews about the internal and marginal misfits of fixed prostheses have identified a limited number of clinical studies, suggesting the need for further research on the subject. Although the replica technique has been described as suitable for this purpose, few studies have validated it.

PURPOSE

The purpose of this in vitro study was to compare the ability of a nondestructive replica technique and a destructive cementation technique to assess internal and marginal misfits of zirconia copings, considering current materials and designs.

MATERIAL AND METHODS

Twelve anatomic prefabricated abutments (Neodent) were used to manufacture zirconia copings following the Ceramill (Amann Girrbach AG) (n=6) and Lava (3M ESPE) (n=6) systems. Replications of the cementation line were obtained with polyvinyl siloxane for the replica technique, and the copings were then cemented and sectioned to obtain 5 surfaces (buccal, palatal, mesial, distal, and incisal) and the linear and angle regions (internal axiogingival and axioincisal angles). The thickness of the cement line and silicone film was measured at 45 reference points on each abutment. A total of 540 measurements were made with an optical microscope with a digital camera at magnifications of ×100 and ×200. Data were analyzed by repeated-measures ANOVA and the Bonferroni multiple comparison tests (α=.05).

RESULTS

In the internal misfit evaluation, the mean values observed for the cementation technique and replica technique were as follows: angle regions, 70.6 μm and 72.2 μm; linear regions, 59.1 μm and 59.6 μm; incisal surface, 139.0 μm and 139.8 μm; buccal surface, 72.4 μm and 73.8 μm; palatal surface, 73.1 μm and 75.2 μm; mesial surface, 74.1 μm and 73.8 μm; distal surface, 75.0 μm and 76.3 μm; and overall mean, 73.6 μm and 74.8 μm, respectively. In the evaluation of the marginal misfit, the mean values found were: buccal surface, 36.7 μm and 37.8 μm; palatal surface, 37.5 μm and 36.8 μm; mesial surface, 44.0 μm and 43.7 μm; and distal surface, 44.6 μm and 45.2 μm, respectively. No significant differences were found between the 2 techniques for all locations and systems (P>.05).

CONCLUSIONS

Within the limitations of this in vitro study, both techniques presented the same ability to assess the internal and marginal misfits when the location and overall mean averages were evaluated (P>.05).

Fit of tooth-supported zirconia single crowns-A systematic review of the literature

PURPOSE

The purpose of this study is to systematically map all the factors that influence the fit and adaptation of zirconia crowns and/or copings.

MATERIALS AND METHODS

The investigational strategy involved carrying out an electronic search between December 1, 2009 and September 1, 2019 through the Embase and Medline databases using Boolean operators to locate appropriate articles.

RESULTS

A total of 637 articles were discovered after the removal of duplicates, and 46 of these were selected for evaluation. Further, a quality assessment was performed using GRADE evaluation criteria.

CONCLUSIONS

Shoulder finish line preparations had slightly better marginal fit compared to chamfer finish lines. Crowns obtained from digital impressions had comparable to superior marginal adaptation compared to conventional impressions. Increasing cement space showed to improve zirconia crown adaptation. Cementation and veneering zirconia frameworks found to increase the marginal and internal gaps. Limited information is available on the effect of the alteration of sintering time/Temperature and/or sintering techniques on the adaptation of zirconia crowns. Most of the selected studies had a moderate quality assessment evaluation. Future studies could investigate the chair-side, ultra-fast sintering effect on the marginal gap of zirconia crowns.

Vertical marginal fit of zirconia copings fabricated with one direct and three indirect digital scanning techniques

STATEMENT OF PROBLEM

Direct digitization of the impression by using an intraoral scanner is a newly introduced technique, but studies comparing the method with other digitization techniques are lacking.

PURPOSE

The purpose of this in vitro study was to compare the marginal accuracy of zirconia copings fabricated with 4 different scanning methods.

MATERIAL AND METHODS

Scans (n=10) of a brass master die were made with a direct method (ISD) in which the die was directly digitized by using an intraoral scanner (IOS) and 3 indirect scanning methods, a conventional impression with polyvinyl siloxane material digitized with either the same IOS (ISI) or with a laboratory extraoral scanner (ESI), or a cast from the impression was scanned by using a laboratory extraoral scanner (ESC). Forty zirconia copings were milled from presintered zirconia blanks and sintered. The vertical marginal gap was measured at 12 points on the master die by using a digital microscope. One-way ANOVA was used to compare the mean differences among the 4 groups, and post hoc analysis was used for pairwise comparison of the groups (α=.05).

RESULTS

The mean ±standard deviation of the vertical marginal gap was 73 ±7 μm in the ISD group, 109 ±36 μm in the ISI group, 42 ±4 μm in the ESI group, and 97 ±5 μm in the ESC group. The lowest marginal gap was seen in the ESI group, which was significantly different from the 3 other groups (P≤.001). The copings in the ISD group had a significantly lower marginal gap than those in the ISI (P=.04) and ESC (P<.001) groups. However, the ISI and ESC groups were not significantly different (P=.69).

CONCLUSIONS

Marginal adaptation of all zirconia copings fabricated with these 4 scanning techniques was within a clinically acceptable range. However, ESI was the best method of digitization and yielded copings with minimum vertical marginal gap.

Reliability of digital measurement methods on the marginal fit of fixed prostheses: A systematic review and meta-analysis of in vitro studies

STATEMENT OF PROBLEM

Digital methods have been increasingly used to evaluate the fit of prostheses, but the accuracy of digital methodology has not been fully clarified.

PURPOSE

The purpose of this systematic review and meta-analysis was to assess the reliability of digital measurement methods for evaluating the marginal fit of fixed dental prostheses (FDPs) and to identify the potential factors that can influence the accuracy of the measurement methods.

MATERIAL AND METHODS

The differences between digital and conventional measurement methods were analyzed by searching PubMed, Scopus, Web of Science, and Google Scholar databases for studies reporting the marginal fit of FDPs. The agreement of data collection among the reviewers was confirmed by the Cohen kappa coefficient, and the MINORS scale was used to rate the quality of the included studies. The heterogeneity among the studies was evaluated, and meta-analyses with global and subgroup analyses were performed.

RESULTS

Ten in vitro studies were selected according to the eligibility criteria with substantial interreader concordance (κ=0.88). The standard mean difference of the meta-analysis for marginal discrepancy was 0.12 μm (95% confidence interval: -0.12 to 0.35), indicating that no statistically significant differences were found in the marginal discrepancies observed with digital and conventional methods (P=.343). The subgroup analysis for alloy-based prostheses was not significantly different, nor between the material and measurement methods (P=.060).

CONCLUSIONS

Digital methods appear to be reliable as an alternative to conventional methods for evaluating the marginal fit of FDPs. To confirm the results of this study and to identify the influencing factors on the accuracy of digital measurement methods, further controlled laboratory and clinical studies are needed.

Comparison of three-dimensional digital technique with two-dimensional replica method for measuring marginal and internal fit of full coverage restorations

PURPOSE

This study compared digital (reference point matching) and replica methods for measuring marginal and internal fit of full coverage restorations.

MATERIALS AND METHODS

A maxillary left first molar typodent was fixed on to an aluminum base and prepared to receive all-ceramic full coverage restoration. The model was scanned with an intraoral scanner (CEREC Omnicam, Sirona, York, PA, USA). Twelve crowns were fabricated from lithium disilicate blocks (IPS emax CAD, Ivoclar Vivadent) and then crystalized. Marginal and internal fit of each restoration was measured by two examiners using replica and a new digital three-dimensional technique. Reliability between the two methods and two examiners was assessed by correlation and Cronbach's Alpha coefficient (P<.05). A Bland-Altman assessment for agreement was used to compare the two methods.

RESULTS

Bland-Altman assessment showed that the mean of difference for marginal, absolute marginal, and axial gap was respectively -1.04 µm, -41.9 µm, and -29.53 µm with limit of agreement (LOA) between -37.26 to 35.18 µm for marginal, -105.85 to 22.05 µm for absolute marginal and -80.52 to 22.02 µm for axial gap. Positive correlation for repeatability (P<.05) in determining marginal and internal gaps by the two examiners in both techniques was revealed. Reliability of both techniques in all sites of measurements was at least good (0.8 ≤ α < 0.9).

CONCLUSION

Both measuring techniques appeared highly reliable for evaluating fit of fixed dental restorations, while reference point matching provided higher values in axial and absolute marginal gap assessment.

Marginal and internal fit of three-unit zirconia fixed dental prostheses: Effects of prosthesis design, cement space, and zirconia type

PURPOSE

The purpose of this study was to compare the marginal and internal fit of three-unit fixed dental prostheses (FDPs) fabricated using CAD/CAM with two designs, two cement space (CS), and two zirconia types.

METHODS

A master model with two zirconia abutments and a missing tooth was scanned with an intraoral scanner. FDPs were fabricated with two designs (Full contour: FC, Framework: FW), two zirconia types (multi-layer: L, single-layer: W), and two CS values (30 and 45 μm for L and 30 μm for W). There were six experimental groups. The fit of the FDPs was evaluated using the replica method. The space between an abutment and the FDPs in the marginal (MO), chamfer (CH), axial (AX), and occlusal (OC) areas was measured under an optical microscope and the data was statistically analyzed using three-way ANOVA and Bonferroni test (p < 0.05).

RESULTS

FW-l-45 μm showed a significantly smaller space than those for the FC in MO (p = 0.011), CH (p = 0.001) and AXE (p = 0.003). FW-l-30 μm showed a significantly smaller space than that for the 45 µm in AXE (p = 0.000) and OC (p = 0.016). FW-W-30 µm showed a significantly smaller space than that for the L in MO (p = 0.000), CH (p = 0.000), AXE (p = 0.000), and OC (p = 0.002).

CONCLUSIONS

The design and CS of the FDPs affected the fit. FDPs with single-layer zirconia showed better fit than that obtained with multi-layer zirconia.

New Intraoral Scanner-Based Chairside Measurement Method to Investigate the Internal Fit of Crowns: A Clinical Trial

To measure the internal fit of the computer-aided designed/computer-aided manufactured (CAD/CAM) crowns, a new scanner-based chairside approach was investigated in patients, and the results were compared to the established silicone replica technique and a digital laboratory replica method. Thirty full-coverage crown preparations were included. Based on a digital impression with an intraoral scanner (IOS, Trios 3), three CAD/CAM measurement copings (‘COM’, resin composite; ‘ZIR’, zirconium dioxide; ‘NPA’, non-precious alloy) were fabricated for each tooth preparation. The internal fit of the measurement copings was analyzed with three different evaluation methods: IOS-based digital approach (D-IOS), digital replica method with laboratory software (D-GOM), and conventional silicone replica technique (CV-SR). The congruence between the determined target parameter of the 80-µm cement space and the actual measured internal gap was investigated. Statistical analysis was performed by ANOVA (p-value < 0.05). No significant difference was determined between the three evaluation methods. However, significant differences were observed for the three coping materials (p-value < 0.05), the single measurement position (marginal, axial, and occlusal fit) (p-value < 0.05), and the interaction between the coping material and the measurement position (p-value < 0.05). COM revealed the smallest internal gap, followed by ZIR and NPA. Regardless of the coping material, the occlusal gap was higher than the axial and marginal gaps. Furthermore, only the internal gaps of the marginal area almost matched the target parameter of 80-µm for the cement space. D-IOS is effective for measuring internal fit of single crowns in different clinical settings.

A systematic review on the accuracy of zirconia crowns and fixed dental prostheses

Purpose

The aim of this study was to review the fit and assess the accuracy of tooth-supported single and multi-unit zirconia fixed dental prostheses.

Background

The fit of zirconia restorations has been reported in several studies, but the accuracy of the manufacturing process is seldom discussed or used when drawing conclusions on the fit.

Materials and methods

A literature search of articles published in PubMed between 2 March 2013 and 1 February 2018 was performed using clearly defined inclusion and exclusion criteria. 841 articles were found and 767 were excluded after screening the title and abstract. After full-text analysis another 60 articles were excluded which left 14 articles to be included for data extraction. Fit was the mean of distances reported in the studies and accuracy was the fit minus the pre-set spacer

Results

For marginal gap of single crowns and multi-unit FDPs combined, the fit was 83 μm and the accuracy was 59 μm. The internal gap fit was 111 μm and the accuracy 61 μm. For the total gap, the fit was 101 μm, and the accuracy of the zirconia restorations was 53 μm.

Conclusions

Within the limitations of the present systematic review the fit of zirconia single crowns and multi-unit FDPs may be regarded as clinically acceptable, and the accuracy of the manufacturing of zirconia is ∼60 μm for marginal, internal, and total gap. Also, digital impressions seem to be associated with a smaller gap value.

Chairside measurement of the marginal and internal fit of crowns: a new intraoral scan-based approach

OBJECTIVES

To investigate the marginal and internal fit of crowns, a new intraoral scanner-based digital approach for chairside measurement (D-IOS) was systematically analysed and compared with the conventional silicone replica technique (CV-SR) and digital 3D analysis software (D-GOM).

MATERIALS AND METHODS

Two models, representing different clinical situations, were constructed, and the first molar was prepared for a full-coverage crown. On the basis of an intraoral scan (Trios 3), copings of three different materials (non-precious alloy, zirconium dioxide, and resin composite) with two different cement spaces (80 μm, 50 μm) were manufactured. The fit of the copings was investigated by all three methods (CV-SR, D-IOS, D-GOM). Therefore, the cement space was visualized with low-viscosity silicone and digitalized with a second intraoral scan. Evaluation of fit by the D-IOS-method was measured in the intraoral scanner software, whereas for analysis by D-GOM, both intraoral scan datasets were transferred to 3D analysis software (GOM Inspect). The CV-SR-method was used as a control group. For all copings, the measurements were repeated five times. The data were analysed with ANOVA.

RESULTS

No significant differences between the three evaluation methods and the coping materials were shown. However, in the occlusal area, the internal gap was significantly higher compared to the internal gap in the marginal and axial areas regardless of the cement space setting (p < .05). The target parameter of the cement spaces did not match the actual measured internal gaps.

CONCLUSIONS

All three evaluation methods and coping materials can be used for the measurement of fit within different clinical situations.

CLINICAL RELEVANCE

The digital chairside measurement implemented in the intraoral scanner software enables an easy, applicable evaluation of fit of crowns without additional laboratory devices or special software applications.

Effect of tooth preparation design on marginal adaptation of composite resin CAD-CAM onlays

STATEMENT OF PROBLEM

Although different preparation designs have been proposed for onlays fabricated by computer-aided design and computer-aided manufacturing (CAD-CAM), their effect on marginal adaptation is unclear.

PURPOSE

The purpose of this in vitro study was to investigate the effect of tooth preparation designs on the marginal and internal adaptation of ceramic-reinforced composite resin CAD-CAM onlays.

MATERIAL AND METHODS

A traditional preparation with a heavy chamfer on the functional cusp and a contrabevel on the nonfunctional cusp and a shoulder preparation with equal reduction on all cusps were used for mesial-occlusal-distal (MOD) onlay preparations. Ceramic-reinforced composite resin onlays were designed and milled based on the scanned prepared teeth. A digital silicone replica technique was used to determine marginal discrepancies between preparations and onlay restorations. A total of 100 numeric distances (representations of the fit in each region) were measured in 3 distinct regions: the buccal margin, lingual margin, and internal area. Independent Student t tests were used to determine significant differences (α=.05).

RESULTS

Traditional preparation designs resulted in significantly smaller overall discrepancies (50.9 ±0.5 μm and 139.1 ±5.4 μm, P<.001) and smaller marginal discrepancies in the buccal (49.7 ±1.4 μm and 135.8 ±2.2 μm, P<.001) and lingual areas (47.1 ±1.0 μm and 133.4 ±1.1 μm, P<.001).

CONCLUSIONS

The marginal adaptation of ceramic-reinforced composite resin CAD-CAM onlays was affected by the preparation design. The traditional preparation design offered better marginal adaptation; therefore, it is recommended in clinical practice.

Trueness of the Inner Surface of Monolithic Crowns Fabricated by Milling of a Fully Sintered (Y, Nb)-TZP Block in Chairside CAD-CAM System for Single-visit Dentistry

A single-visit zirconia restoration can be easily achieved if direct milling of a fully sintered zirconia block can be performed without much effort. However, no studies have yet been reported regarding the evaluation of the trueness of crown fabricated from chairside-milling of a fully sintered zirconia block in the chairside computer-aided design and computer-aided manufacturing (CAD–CAM) system for single-visit dentistry. This in vitro study aimed to evaluate the trueness of crowns fabricated by milling a fully sintered zirconia block in the chairside CAD–CAM system and investigate the clinical implications for single-visit chairside restoration. Crowns were fabricated either by chairside-milling a fully sintered block of niobium oxide containing yttria-stabilized tetragonal zirconia polycrystals ((Y, Nb)-TZP) without the sintering process (n = 12) in a chairside single-visit dentistry system (Chairside group) or by laboratory-milling a partially sintered 3 mol% block of yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP) followed by the sintering process (n = 12) in a conventional laboratory system (Labside group). Crown fabrication time, milling tool diameter and the trueness of each crown were evaluated. All trueness values of both groups were within the clinically acceptable range, although a significant difference between the Chairside (43.0 ± 3.67 μm) and Labside groups (37.4 ± 2.41 μm) was observed (P < 0.05). Mean fabrication time was 0.52 h and 1.42 h for Chairside and Labside groups, respectively. A decrease in the tool diameter was observed for the Chairside group.

Evaluation of marginal adaptation of Co-Cr-Mo metal crowns fabricated by traditional method and computer-aided technologies

Background/purpose

The purpose of this study was to evaluate the marginal gaps of dental restorations manufactured using conventional loss wax and casting, computer-aided design/computer-aided manufacturing (CAD/CAM), and 3D printing methods.

Materials and methods

A zirconia master die model with an upper right first molar resin crown was prepared as a standardized model. A total of 30 resin master die models were duplicated from this standard model. Simultaneously, 10 Co—Cr—Mo metal crowns were individually obtained using the conventional loss wax and casting method (Group A), selective laser sintering (Group B), and CAD/CAM (Group C), respectively. The marginal gaps between the crowns fabricated conventional and digital methods with master die models were calculated using a 3D replica and mapping technique.

Results

Statistical analyses revealed there were significant differences in the marginal gaps in the group A with group B and C (p < 0.05). The mean marginal gaps between dental crowns with die models were 76 ± 61 μm, 116 ± 92 μm, and 121 ± 98 μm for groups A, B, and C, respectively.

Conclusion

Within the limitations of this study, the marginal gaps were clinical acceptable in conventional and digital techniques.

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

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

Marginal and internal fit of CAD-CAM inlay/onlay restorations: A systematic review of in vitro studies

STATEMENT OF PROBLEM

Different parameters can influence the adaptation of computer-assisted design and computer-assisted manufacturing (CAD-CAM) inlay/onlay restorations. However, systematic reviews to identify and discuss these parameters are lacking.

PURPOSE

The purpose of this systematic review was to summarize the scientific literature investigating all parameters that can influence both the marginal and internal adaptation of CAD-CAM inlay/onlay restorations.

MATERIAL AND METHODS

An electronic search was conducted by 2 independent reviewers for studies published in English between January 1, 2007 and September 20, 2017 on the PubMed/MEDLINE, Scopus, and Web of Science databases and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Factors investigated in the selected articles included the type of CAD-CAM system, virtual space parameters, version of the software, type of block, luting procedure, type of restoration, sample size and aging procedure, evaluation method, and number of measurement points per specimen.

RESULTS

A total of 162 articles were identified, of which 23 articles met the inclusion criteria. Nine studies investigated adaptation with different restorative materials, 2 evaluated adaptation according to the type of preparation design, 9 compared adaptation before/after thermomechanical loading, and 2 before/after cementation, 1 study investigated marginal adaptation based on whether the optical scan was made intraorally or extraorally, 1 compared adaptation with 5 and 3 axis CAM systems, and 1 assessed adaptation with 4 different intraoral scanners. The risk of bias was high for 7, medium for 15, and low for 1 of the studies reviewed. The high level of heterogeneity across the studies excluded meta-analysis.

CONCLUSIONS

Most of the studies reported clinically acceptable values for marginal adaptation. The performance of a CAD-CAM system is influenced by the type of restorative material. A nonretentive cavity preparation exhibited better adaptation than a retentive preparation. Most studies showed that thermomechanical loading affected the quality of marginal adaptation. Cementation increased marginal discrepancies. No statistically significant difference was found for marginal fit of onlays between intraoral and extraoral optical scans using a stone die. The number of milling axes, the type of digital camera, and the region measured were statistically significant in relation to marginal/internal adaptation. Values of adaptation recorded failed to reproduce the preestablished spacer parameters in the software. Clarification is needed concerning adaptation according to the type of preparation design, the type of material, the choice of intrinsic parameters for the CAD process, the type and shape of milling instruments, and the behavior of the material during milling. Adaptation of CAD-CAM inlay/onlays should be evaluated under clinical conditions.

Evaluation of the fit of zirconia copings fabricated by direct and indirect digital scanning procedures

STATEMENT OF PROBLEM

Intraoral scanners are effective for direct digital scans when dental restorations are fabricated using computer-aided design and computer-aided manufacturing (CAD-CAM); however, if the abutment tooth cannot be dried completely or the prepared margin is placed subgingivally, accurate digital images cannot always be guaranteed.

PURPOSE

The purpose of this in vitro study was to compare the internal and marginal discrepancies of zirconia copings fabricated directly using an intraoral scanner with those fabricated indirectly with impression scanning.

MATERIAL AND METHODS

Forty-five resin dies fabricated with a 3-dimensional (3D) printer were divided into 3 groups: direct scanning (DS), impression scanning (IMP), and lost-wax casting (LW). For the DS group, a resin die was scanned with an intraoral scanner (Trios; 3Shape), whereas for the IMP group, impressions made with polyether were scanned with a cast scanner (D700; 3Shape). The zirconia copings were fabricated in the same way in the DS and IMP groups. For the LW group, impressions were made in the same way as in the IMP group, and Ni-Cr alloy copings were fabricated using LW. The marginal and internal discrepancies of the copings were measured by cementing them onto resin dies, embedding them in acrylic resin, and sectioning them in a buccolingual direction. The cement layer was measured, and the Kruskal-Wallis test was used to detect significant differences (α=.05). A nonparametric Friedman test was also performed to compare the measurements of each group by location (α=.05).

RESULTS

The mean marginal discrepancies in the DS, IMP, and LW groups were 18.1 ±9.8, 23.2 ±17.2, and 32.3 ±18.6 μm (mean ±standard deviation), respectively. The mean internal discrepancies of the DS, IMP, and LW groups in the axial area were 38.0 ±9.1, 47.0 ±16.3, and 36.5 ±15.8 μm, and those in the occlusal area were 36.7 ±16.9, 33.4 ±21.6, and 44.5 ±31.9 μm, respectively. No statistically significant differences were found in marginal or internal discrepancies among groups (P>.05).

CONCLUSIONS

Within the limitations of this study, the zirconia copings fabricated with CAD-CAM using different digitization methods and Ni-Cr copings fabricated using the lost-wax technique and casting produced clinically acceptable marginal and internal discrepancies. No significant differences were found among the DS, IMP, and LW groups.