A comparison of the marginal and internal fit of porcelain laminate veneers fabricated by pressing and CAD-CAM milling and cemented with 2 different resin cements

Feasibility of images acquired using smartphone camera for marginal and internal fit of fixed dental prosthesis: comparison and correlation study

This study aimed to measure marginal and internal fit using images captured with both an optical microscope and a smartphone camera, comparing the fit measurement performance of these devices and analyzing their correlation. Working casts (with 10 posterior and 10 anterior teeth) created to fabricate fixed dental prostheses were used. These working casts were scanned using a desktop scanner (E1) to design an interim crown, and the designed interim crown was fabricated using a three-dimensional (3D) printer. Utilizing the silicone replica technique, the fabricated interim crown replicated the fit, which was then captured using both an optical microscope and a smartphone camera. The captured images were used to measure the marginal and internal fit according to the imaging device. Intraclass correlation coefficients (ICC) were used for reliability analysis according to the imaging device. Furthermore, the Wilcoxon signed-rank test was adopted for the comparative evaluation of the marginal and internal fit between the imaging devices (α = 0.05). The measurement results of the marginal and internal fit according to the optical microscope and smartphone camera did exhibit a significant difference (P < 0.05). The ICC between the two devices showed an "excellent" agreement of over 0.9 at all measurement points (P < 0.001). A smartphone camera could be used to obtain images for evaluating the marginal and internal fit.

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.

Evaluation of the ceramic laminate veneer-tooth interface after different resin cement excess removal techniques

OBJECTIVES

To compare, in vitro, resin cement excess removal techniques at the veneer-tooth interface.

MATERIALS AND METHODS

Anterior human teeth were restored with ceramic veneers and randomly divided according to the following techniques (n = 10): removal of excess resin cement with brush and dental floss, followed by light-curing with Valo (Group 1) or Elipar (Group 2) for 1 min and 40 s; tack-curing with Valo (Group 3) or Elipar (Group 4) for 1 s; and tack-curing with Valo (Group 5) or Elipar (Group 6) for 5 s. The tack-curing was followed by removal of excess with probe and dental floss and light-curing for 1 min and 40 s. The area of excess resin cement (mm2) was measured in micro-CT images using AutoCAD program. The failures at the cervical margin in the X, Y, and Z axes (µm) of greater value were measured using the DataViewer program. The specimens were submitted to microleakage with 2% basic fuchsin.

RESULTS

According to the Kruskal-Wallis and multiple comparison test, the highest area of excess resin cement was found in Group 1 (5.06 mm2), which did not differ statistically from Groups 2 (3.70 mm2) and 5 (2.19 mm2). Groups 2, 3 (1.73 mm2), 4 (1.14 mm2), and 5 (2.18 mm2) did not differ statistically. Group 6 (0.77 mm2) obtained the lowest value, which did not differ statistically from Groups 3 and 4. According to the Kruskal-Wallis and Dunn test, there was no significant difference in failures in X (p = 0.981), Y (p = 0.860), and Z (p = 0.638) axes and no significant difference in microleakage (p = 0.203) among the groups.

CONCLUSIONS

Tack-curing for 1 s or 5 s, followed by removal of excess resin cement using a probe and a dental floss, tended to result in a lower amount of excess material around the margin.

CLINICAL RELEVANCE

The technique used for resin cement excess removal influences the amount of excess leaved at the veneer-tooth interface. Tack-curing for 1 s or 5 s is recommended to mitigate the excess resin cement.

Effect of a modified laminate veneer preparation design on absolute margin discrepancy and marginal overhang

STATEMENT OF PROBLEM

Veneer preparation designs impact veneer accuracy. However, whether a modified design could reduce absolute margin discrepancy and marginal overhangs is unclear.

PURPOSE

The purpose of this in vitro study was to investigate whether a modified veneer preparation design enhances the absolute margin discrepancy and marginal overhang.

MATERIAL AND METHODS

The absolute margin discrepancy and the marginal overhang of 3 different veneer preparation designs on a typodont tooth (n=20): feather edge, shoulder, and shoulder with wings were measured. The feather edge design was prepared first and subsequently modified to create the shoulder and shoulder with wings preparations. Ceramic veneers were fabricated using computer-aided design and computer-aided manufacture with each veneer assessed for fit before cementation. Ten specimens were cut vertically, and 10 were cut horizontally in each group. The absolute margin discrepancy and marginal overhangs were measured for each cross-section with scanning electron microscopy. Descriptive data analysis and hypothesis testing were conducted using the nonparametric Kruskal Wallis test (α=.05).

RESULTS

On the vertical sections, the shoulder with wings preparation had the best absolute margin discrepancy and overhang. The design was also best for mesial overhang and mesial absolute margin discrepancy when measuring horizontally.

CONCLUSIONS

The shoulder with wings preparation design produced the smallest cervical absolute margin discrepancy and overhang. This design also produced absolute margin discrepancy and overhangs comparable with those of the shoulder design in the proximal areas.

Influence of intraoral scanner and finish line location on the fabrication trueness and margin quality of additively manufactured laminate veneers fabricated with a completely digital workflow

STATEMENT OF PROBLEM

Knowledge of the fabrication trueness and margin quality of additively manufactured (AM) laminate veneers (LVs) when different intraoral scanners (IOSs) and finish line locations are used is limited.

PURPOSE

The purpose of this in vitro study was to evaluate the fabrication trueness and margin quality of AM LVs with different finish line locations digitized by using different IOSs.

MATERIAL AND METHODS

An LV preparation with a subgingival (sub), equigingival (equi), or supragingival (supra) finish line was performed on 3 identical maxillary right central incisor typodont teeth. Each preparation was digitized by using 2 IOSs, (CEREC Primescan [PS] and TRIOS 3 [TS]), and a reference LV for each finish line-IOS pair (n=6) was designed. A total of 90 LVs were fabricated by using these files and urethane acrylate-based definitive resin (Tera Harz TC-80DP) (n=15). Each LV was then digitized by using PS to evaluate fabrication trueness (overall, external, intaglio, and marginal surfaces). Each LV was also qualitatively evaluated under a stereomicroscope (×60), and the cervical and incisal margin quality was graded. Fabrication trueness and cervical margin quality were evaluated by using 2-way analysis of variance, while Kruskal-Wallis and Mann Whitney-U tests were used to evaluate incisal margin quality (α=.05).

RESULTS

The interaction between the IOS type and the finish line location affected measured deviations at each surface (P≤.020). PS-sub and TS-supra had higher overall trueness than their counterparts. and the subgingival finish line resulted in the lowest trueness (P≤.005). PS and the subgingival finish line led to the lowest trueness of the external surface (P≤.001). TS-sub had the lowest intaglio surface trueness among the TS subgroups, and PS-sub had higher trueness than TS-sub (P<.001). PS-sub and PS-supra had higher marginal surface trueness than their TS counterparts (P<.001). TS resulted in higher cervical margin quality (P=.001).

CONCLUSIONS

Regardless of the IOS tested, subgingival finish lines resulted in the lowest trueness. The effect of IOS on the measured deviations varied according to the surface evaluated and finish line location. The cervical margin quality of AM LVs was higher when TS was used.

Marginal and internal fit of porcelain laminate veneers: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Marginal integrity and internal adaptation are key to the long-term success of porcelain laminate veneers. Evidence for their marginal and internal fit is unclear, and the factors affecting such fit have not been identified.

PURPOSE

The purpose of this systematic review and meta-analysis was to summarize the scientific literature assessing the effects of various parameters on the marginal and internal fit of porcelain laminate veneers.

MATERIAL AND METHODS

An electronic search was conducted to identify all relevant published articles on the fit accuracy of ceramic veneers between January 2000 and June 2021 in the PubMed-MEDLINE, Scopus, Embase, Google Scholar, and Web of Science databases. Information, including the study outcomes, in terms of the mean marginal gap, internal gap, and absolute marginal discrepancies of porcelain laminate veneers, was extracted from the selected studies. The inverse-variance random effects model was used to analyze the pooled results and estimate the overall effect based on the heterogeneity of studies (α=.05).

RESULTS

Twenty-one studies were selected for analysis, 2 clinical and 19 in vitro. The risk of bias was "medium" for most studies (19 of 21), and only 2 studies were classified as "high risk." A mean difference of -4.53 μm (95% CI: -21.46 to 12.41) was found, with no statistically significant difference in marginal gap between the pressed and milled fabrication modes (P=.600). As for the internal gap, significant differences were found (mean difference=-40.56 μm; 95% CI: -76.54 to -4.58), with pressed veneers performing better (P=.030). Butt joint preparation design produced significantly (P=.002) lower marginal gaps than the palatal chamfer (mean difference=-14.02 μm; 95% CI: -23.07 to -4.98).

CONCLUSIONS

No significant differences were found between the pressed and milled porcelain laminate veneers for marginal gap, but for the internal gap, the differences were significantly in favor of the pressed type. The butt joint veneer preparation design was significantly better than the palatal chamfer design in terms of marginal fit.

Influence of Mono- and Multiwave Light-curing Units on the Microhardness and Degree of Conversion of Light-cured Resin Cements

OBJECTIVES

This study evaluated the Knoop hardness (KH, N/mm2) and degree of conversion (DC, %) on the margins of light-cured resin cements with different photoinitiators using a single light-curing unit (LCU) with two heads (mono- and multiwave).

METHODS AND MATERIALS

Three types of resin cements were used with different photoinitiators: Megalink Esthetic (Odontomega, São Paulo, Brazil) with a camphorquinone photoinitiator; Allcem Veneer (FGM, Joinville, Brazil) with the Advanced Polymerization system (APS), and Variolink Esthetic LC (Ivoclar Vivadent, Schaan, Liechtenstein). Thirty samples were collected and divided into six groups (n=5 each). The resin cement samples were made into the shape of a maxillary right central incisor and photoactivated under a 0.5-mm-thick ceramic sheet. A single LCU (Radii Xpert, SDI) with two heads (mono- and multiwave) was used. The tip of the LCU was positioned at the center of the sample in a standardized manner. Raman spectroscopy was performed to evaluate the DC, and KH was evaluated through the Knoop microhardness test. Five regions were evaluated: cervical, mesial, buccal (center), distal, and incisal.

RESULTS

There was a significant difference in the DC only for the type of cement (p<0.001), indicating that the cement with the APS photoinitiator presented excellent results. There were significant differences in the type of cement (p<0.001), type of light (p<0.001), region (p<0.001), and the interaction between the type of cement and type of light (p<0.001). The resin cement with the APS photoinitiator cured with monowave light showed the highest KH values. The beam profiles of all groups, with and without the interposition of ceramic and resin cement, were examined by light transmission.

CONCLUSIONS

The cement with the APS photoinitiator presented the best results with respect to the DC and KH. In comparison with mono- and multiwaves, the LCU may not be a determining factor for the properties of light-cured resin cements. The buccal region showed the best results for DC and KH, indicating the need for a greater amount of light-curing at the cementation margins.

Printed Digital Wax-up Model as a Blueprint for Layered Pressed-ceramic Laminate Veneers: Technique Description and Case Report

This article presents a clinical technique for transferring Digital Smile Design (DSD) information and a digital wax-up to fabricate highly personalized ceramic laminate veneers. The hybrid workflow of digitally designed wax-up and conventional hand-crafted veneers is showcased in a female adult who sought to improve her smile due to maxillary anterior incisal wear. The ceramic veneers, layered by feldspathic porcelain, followed the contours and shade blueprint planned with the digital wax-up. The DSD improved the harmony of the facial-and-smile relationship, and the ceramic restorations fulfilled the patient's esthetic and functional demands. Guides based on the printed model with the digitally designed wax-up can provide a reference for pressed lithium disilicate veneers layered with feldspathic porcelain.

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.

SEM Evaluation of the Marginal Accuracy of Zirconia, Lithium Disilicate, and Composite Single Crowns Created by CAD/CAM Method: Comparative Analysis of Different Materials

(1) Background: The objective of this in vitro study is to evaluate the marginal accuracy of crowns created by CAD/CAM. (2) Methods: A customized chrome-cobalt (Cr-Co) implant abutment simulating a maxillary right first molar was fixed in a hemi-maxillary stone model and scanned. In total, 27 crowns were fabricated, including 9 lithium disilicate crowns, 9 composite crowns, and 9 zirconia crowns. The measurements were determined by scanning electron microscopy. Descriptive analysis was performed using the mean and standard deviation, while the Kruskal-Wallis test was performed to determine whether the marginal discrepancies were significantly different between each group (p < 0.05). (3) Results: The lowest marginal gap value was reported for zirconia (21.45 ± 12.58 µm), followed by composite (44.7 ± 24.96 µm) and lithium disilicate (62.28 ± 51.8 µm). The Kruskal-Wallis tests revealed a statistically significant difference (p-value < 0.05) in the mean marginal gaps between different materials. (4) Conclusions: The proposed digital workflow can be a viable alternative for fixed prosthetic rehabilitations. The best performance in terms of marginal gap was achieved by zirconia crowns, but all three materials demonstrate marginal closure below the clinically accepted threshold value (120 µm). Clinical significance: although significant differences were reported, the investigated CAD/CAM materials showed clinically acceptable marginal gaps.

Evaluation of Marginal and Internal Fit of Ceramic Laminate Veneers Fabricated with Five Intraoral Scanners and Indirect Digitization

The long-term success of ceramic laminate veneers (CLVs) is influenced by the marginal and internal fit of the restorations. However, studies comparing the fit of CLVs using different intraoral scanners or the indirect digitization technique are lacking. The purpose of this study was therefore to assess the marginal and internal fit of CAD/CAM-milled CLVs using different intraoral scanners and the indirect digitalization technique. An ivorine typodont maxillary left-central incisor was prepared; the tooth and the neighboring teeth were scanned and used as a template to print ninety 3D partial models. Thereafter, ceramic laminate veneers (CLVs) (N = 90) were milled from IPS-Emax CAD blocks and divided into six equal groups (15 specimens each) according to the type of intraoral scanner (IOS), as follows: Omnicam IOS, SC3600 IOS, Trios 3 IOS, Emerald IOS, I500 IOS. Fifteen further CLVs were fabricated using the conventional indirect digitalization technique. After cementation on the resin dies and embedding in clear epoxy resin, specimens were sectioned inciso-gingivally and mesio-distally. At the incisal and cervical positions, the marginal discrepancy was measured and evaluated in addition to the internal gap at six locations using SEM (200×). Differences between gap measurements among the six groups were determined using ANOVA. Games-Howell multiple comparisons for homogenous variances and LSD multiple comparisons for non-homogenous variances were used with 95% confidence intervals. The significance level was set at 0.05. The lowest mean absolute marginal gap at the incisal margins (AMGI) was recorded for Omnicam group (203.28 ± 80.14) µm, while the highest mean absolute marginal gap at the cervical margins (AMGC) was recorded for Omnicam group (147.16 ± 59.78) µm. The mean AMGC was reported to be significantly different between the conventional technique (146.75 ± 38.43) µm and Trios 3 (91.86 ± (35.51) µm; p = 0.001) and between Emerald (112.37 ± (50.31) µm; p = 0.042) and I500 (86.95 ± (41.55) µm; p < 0.001). The mean MGI was found to be significantly different between the conventional technique (114.11 ± (43.45) µm and I500 group (186.99 ± (73.84) µm) only (p = 0.035). However, no significant differences were found in the mean MGI between all types of IOSs. The means of AMG and MG were significantly different at incisal or cervical areas between the conventional technique and IOSs and within the scanner groups (p > 0.05). Marginal gaps were higher in the incisal region compared to the cervical region with both the indirect digitization technique and the IOSs. Ceramic laminate veneers (CLVs) fabricated using IOSs produced overall internal and marginal fit adaptation results comparable to CLVs fabricated from the indirect digitalization method, and both techniques produced clinically acceptable results.

Effect of ceramic and resin cement type on color stability and translucency of ceramic laminate veneers for diastema closure: an in vitro study

To investigate the effect of resin cements on the color stability and translucency of ceramic laminate veneers used for diastema closure. Sixty resin abutments were prepared for ceramic laminate veneers and divided into six groups according to the ceramic type (lithium disilicate, zirconia-reinforced lithium silicate, and translucent zirconia) and the cement type (Variolink Esthetic LC and RelyX Veneer). Color coordinates and translucency were analyzed after cementation and after soaking in the coffee solution. Differences in color and translucency were estimated, and results were statistically assessed (α = 0.05). Ceramic materials showed a significant impact on color changes after soaking in coffee within Variolink Esthetic groups. Translucent zirconia showed the highest color change, followed by zirconia reinforced lithium silicate and lithium disilicate. Ceramic materials showed a significant impact among the RelyX Veneer groups. A significant interaction in color changes was found between ceramic types and cement types after cementation, and after soaking in coffee was found. All groups showed a clinically acceptable difference in translucency parameters after soaking in coffee. The resin cement affects the color and translucency of ceramic laminate veneers used for diastema closure, and ceramic laminate veneers bonded with Variolink Esthetic LC resin cement are more translucent, while ceramic laminate veneers bonded with RelyX Veneer resin are more resistant to coffee staining. The lithium disilicate laminate veneer is more resistant to coffee staining than zirconia reinforced lithium silicate and translucent zirconia laminate veneers used for diastema closure.

Marginal Adaptation of Veneers: A Systematic Review

This study aimed to systematically review the literature to evaluate the marginal adaptation of veneers using different fabrication methods, namely, conventional feldspathic porcelain laminate veneers (PLVs), computer-aided design-computer-aided machining (CAD-CAM) veneers, and pressed veneers. A comprehensive literature search was performed using electronic databases (PubMed and Google Scholar) as well as hand searches to identify all relevant studies related to veneers and marginal adaptation. The identified studies were screened for assessing the inclusion and exclusion criteria. The included articles were then subjected to data extraction and analysis. The search resulted in 130 articles, of which six were included in this systematic review. All included articles were assessed for adaptation of margins. Based on the findings of this systematic review, no significant differences were found in the marginal adaptation of CAD-CAM and conventional feldspathic PLVs. The marginal fidelity of ceramic veneers issuing from the various fabrication techniques was clinically acceptable.

Internal and Marginal Adaptation of Adhesive Resin Cements Used for Luting Inlay Restorations: An In Vitro Micro-CT Study

Adequate internal adaptation and marginal sealing of resin luting cements are of particular importance for the success of cemented ceramic inlays. The purpose of this study was to investigate the initial adaptation of different resin cements at the tooth-inlay restoration interface at enamel versus dentin surfaces. Thirty-two extracted human molars were allocated to four groups. One Class II cavity was prepared in each tooth. In each group, half of the cavities’ gingival floors were on enamel while the other halves were on cementum. Lava Ultimate CAD/CAM inlays were luted to the cavities using the following adhesive systems: RelyX Unicem, RelyX Ultimate, eCement, and Variolink Esthetic DC. After staining teeth with silver nitrate solution, marginal and internal gap volumes were determined using micro-CT images. Statistical analyses were conducted by independent t test and one-way ANOVA followed by post hoc Tukey test (p < 0.05). The internal and marginal gap volume values were the highest for Variolink Esthetic DC at the dentin surface (0.629 ± 0.363) and (2.519 ± 1.007), respectively, and the lowest for RelyX Unicem at the enamel surface (0.005 ± 0.004) and (0.009 ± 0.003), respectively. The internal and marginal adaptation on the enamel surface for RelyX Unicem and RelyX Ultimate resin cements were comparable to each other and to eCement but significantly better than Variolink Esthetic DC cement. Regardless of the adhesive resin system used, adaptation on enamel is superior to that on dentin surfaces.

Digital versus Conventional Workflow in Oral Rehabilitations: Current Status

In recent years, computer-aided design and computer-aided manufacturing (CAD-CAM) technology has developed along with its applications in dentistry, including several new techniques that are used in oral rehabilitation applications [...]

The Computer Aided Design/press technique: Fabrication of zirconia-reinforced lithium disilicate restorations for treatment of extensive noncarious cervical lesions

OBJECTIVE

The aim of this case report is to present the CAD/Press technique; a workflow that combines digital design, milled, or 3D printed burnout molds, and a new pressable ceramic material for the treatment of extensive noncarious lesions with minimal invasive indirect ceramic restorations.

CLINICAL CONSIDERATIONS

Clinical decisions from material selection, preparation design, manufacturing techniques to adhesive protocols will be discussed, as they are important factors for achieving long-term clinical success while preserving healthy tooth structure.

CLINICAL SIGNIFICANCE

The presented workflow aims to ease clinical decisions when restoring extensive cases with indirect restorations and show clinicians a workflow combining several techniques.

Evaluation of Marginal and Internal Fit of a CAD/CAM Monolithic Zirconia-Reinforced Lithium Silicate Porcelain Laminate Veneer System

PURPOSE

To evaluate the marginal and internal fit of monolithic computer-aided design/computer-aided manufacturing (CAD/CAM) ZLS (Vita Suprinity) glass ceramic porcelain laminate veneers (PLVs), in terms of marginal and internal gap widths, in comparison to monolithic lithium disilicate (LDS) [IPS e.max CAD] CAD/CAM veneers, and, also, to analyze the effect of incisal preparation designs (butt joint and chamfer), on the marginal and internal fit accuracy.

MATERIALS AND METHODS

Forty dental stone dies poured from impressions made of two master metal dies with different incisal preparation designs were scanned to produce digital models. Forty ceramic veneers were designed and milled using the virtual models-10 ZLS butt joint, 10 ZLS chamfer, 10 LDS butt joint, and 10 LDS chamfer. The monolithic ceramic veneers produced were then subjected to marginal and internal gap width evaluation using X-ray nano-computed tomography and computerized digital analysis (n = 10). Descriptive analyses of data were performed and the influence of "material" and "preparation design" on the marginal and internal fit of veneers was assessed using 2-way ANOVA (α = 0.05). Bonferroni post-hoc multiple comparison tests were used to further analyze the interactions between the material and preparation design after adjusting the α value by Holm-Bonferroni method (α = 0.01).

RESULTS

Mean marginal and internal gaps for ZLS PLVs were 65 ±11 μm and 112 ±14 μm for butt joint, and 100 ±24 μm and 100 ±21 μm for chamfer, respectively. Corresponding values for LDS PLVs were 78 ±25 μm and 114 ±17 μm for butt joint, and 104 ±18 μm and 106 ±7 μm for chamfer. Marginal gap and internal gap differences between ZLS and LDS PLVs were not significant (marginal gap: F = 1.786, p = 0.190; internal gap: F = 0.807, p = 0.375). However, the preparation designs (butt joint and chamfer) differed significantly in terms of marginal gaps (F = 23.797, p = 0.000), but not internal gaps (F = 3.703; p = 0.059).

CONCLUSIONS

Butt joint margins produced better marginal accuracy in terms of marginal gap, compared to chamfers, for ZLS CAD/CAM laminate veneers.

Micro-CT and Microscopy Study of Internal and Marginal Gap to Tooth Surface of Crenelated versus Conventional Dental Indirect Veneers

Background and Objectives: Ceramic veneers represent the most appropriate treatment option for minimally invasive aesthetic rehabilitation. For long-term clinical success, the accurate marginal and internal adaptation of dental restorations are of paramount importance. The aim of this in vitro study is to assess the effect of a novel (patented) design of veneers compared to conventional ones on their marginal and internal gap to the prepared tooth surface. Materials and Methods: Twenty-four lithium disilicate ceramic veneers are obtained using Computer-Aided-Design (CAD) and then milled using Computer-Aided-Manufacturing (CAM). The samples are divided into two groups: 12 conventional (CO) veneers (i.e., with a linear marginal contour) and 12 crenelated (CR) veneers, the latter with the novel sinusoidal marginal design. All samples are bonded to frontal teeth, and the adhesive interfaces are analyzed using two methods, optical microscopy and micro-Computed Tomography (CT): the former for the accuracy of the marginal gap and the latter for the internal gap (as well as for the homogeneity of the luting cement) of ceramic veneers. Results: STATA and one-way ANOVA tests reveal significant differences between CO and CR veneers: (i) the marginal gap is smaller for CR (64 μm) than for CO veneers (236 μm); (ii) the internal adaptation is better for CR veneers: for a cement width of up to 120 μm, the covered surface for the CR group is 81.5%, while for the CO group it is 64.5%; (iii) the mean of the porosities within the cement is not significantly different (3.4·10⁶ μm³ for CO and 3.9·10⁶ μm³ for CR veneers), with a higher standard deviation for the CO group. Analytical modeling is achieved for internal gaps using the micro-CT results. The characteristic functions obtained allow us to compare the volume of luting cement for the two types of veneers. Conclusion: The novel veneers design produces an improvement in the marginal and internal adaptation of the restorations to the prepared tooth surface. Thus, it provides favorable premises for better clinical performances.

Effect of Die Spacer Thickness on the Fracture Resistance of CAD/CAM Lithium Disilicate Veneers on Maxillary First Premolars

Objective

The purpose of this study was to compare the fracture resistance of ceramic veneers with digital die spacer settings at 20 µm, 40 µm, and 100 µm.

Materials and Methods

Eighteen sound maxillary first premolars were divided into three groups (n=6) according to their digital die spacer settings: group A=20 µm, group B=40 µm, group C=100 µm. Each tooth was prepared to a depth of 0.5 mm to receive lithium disilicate veneers (IPS e.max CAD, Ivoclar Vivadent). All groups were thermocycled (2500 cycles at 5-55°C) and subjected to fracture resistance test using a universal testing machine until failure. Failure modes were examined using a stereomicroscope.

Results

The values (N) for group A=1181.34±301.33, group B=1014.29±291.12, and group C=841.89±244.59. One-way ANOVA showed no statistical difference among the three groups (p=0.145). However, chi-square test showed that a significant difference was present in the modes of failure (p=0.009). Tukey's post hoc test indicated that the failure modes of group A were statistically different from those of group C, showing 83.3% adhesive failure for group A compared to 0% adhesive failures in group C. A p-value of ≤0.05 was considered as statistically significant.

Conclusion

Digital die spacer thickness did not influence the mean fracture resistance values of CAD/CAM lithium disilicate veneers. However, the way the failure occurred differed significantly at various die spacer thicknesses.

Minimum Radiant Exposure and Irradiance for Triggering Adequate Polymerization of a Photo-Polymerized Resin Cement

This study aimed to establish the minimum radiant exposure and irradiance to trigger an adequate polymerization of a photo-polymerized resin cement. In total, 220 disc-shaped specimens (diameter of 10 mm and thickness of 0.1 mm) were fabricated using a photo-polymerized resin cement (Variolink N-transparent, Ivoclar Vivadent). To investigate the minimum radiant exposure, the specimens were polymerized with radiant exposures of 1, 2, 3, 4, 5, 6, and 18 J/cm² (n = 20). During polymerization, the irradiance was maintained at 200 mW/cm². To investigate the minimum irradiance, the specimens were polymerized with irradiances of 50, 100, 150, and 200 mW/cm² (n = 20). During polymerization, the radiant exposure was maintained at the previously determined minimum radiant exposure. The Vickers microhardness (HV) and degree of conversion (DC) of the carbon double bond of the specimens were measured to determine the degree of polymerization of the specimens. The results were analyzed using one-way analysis of variance (ANOVA) and Tukey’s test (p < 0.05). In the investigation of the minimum radiant exposure, the HV and DC of the specimens polymerized with a radiant exposure from 1 to 5 J/cm² were significantly lower than those with 18 J/cm² (all p < 0.05). However, no significant difference in HV and DC was found between the specimens polymerized with 6 J/cm² and 18 J/cm² (p > 0.05). In the investigation of the minimum irradiance, the specimens polymerized with an irradiance of 50 mW/cm² had significantly lower HV and DC than the specimens polymerized with an irradiance of 200 mW/cm² (p < 0.05). However, no significant difference in the HV and DC was found among the specimens cured with irradiances of 100, 150, and 200 mW/cm² (p > 0.05). In conclusion, the minimum radiant exposure and irradiance to trigger an adequate polymerization of the light-cured resin cement were 6 J/cm² and 100 mW/cm², respectively.

Evaluating the effect of repeated use of milling burs on surface roughness and adaptation of digitally fabricated ceramic veneers

Objectives

This study aimed to evaluate how repeated use of milling diamond burs with different coarseness affects surface roughness, and marginal and internal adaptation of CAD/CAM veneers.

Methods

Forty leucite-reinforced glass-ceramic veneers were milled in 2 groups based on the milling mode (with fine or extra-fine bur sets). In each group, every 10 veneers were milled with a new bur set. All veneers were cemented to bovine teeth and then polished. Labial surface roughness was measured before cementation, and after polishing. Marginal and internal discrepancies were measured using a field emission scanning electron microscope. Three-way and two-way mixed repeated measures ANOVA were applied to assess changes in surface roughness values of veneers and discrepancy values, respectively. The Bonferroni correction was applied for multiple comparisons.

Results

Repeated use of a milling diamond bur set had a significant effect on surface roughness of the veneers (P < .001). Mean surface roughness of the fine milling mode was significantly higher in comparison to that of extra-fine mode before (P = .002) and after (P = .01) polishing. After polishing a significant decrease in surface roughness occurred in fine (P = .02), but not in extra-fine milling mode (P = .99). Repeated use of milling burs significantly affected marginal and internal adaptation between some repeated uses.

Conclusions

Marginal and internal adaptation were significantly affected by repeated use of milling diamond burs up to 10 times between some repeated uses. However, no specific pattern could be established.

Clinical significance

Repeated use of milling burs could affect surface roughness, surface microcracks, critical defects, and adaptation of CAD/CAM restorations. Therefore, it plays a major role in clinical success of the restorations.

Evaluation of marginal and internal fit of lithium disilicate CAD-CAM crowns with different finish lines by using a micro-CT technique

STATEMENT OF PROBLEM

Whether the precision of fit of computer-aided design and computer-aided manufacturing (CAD-CAM) complete crowns is affected by the finish line configuration is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal and internal fit of CAD-CAM ceramic crowns made from lithium disilicate based on 3 different finish lines (rounded shoulder, chamfer, feather-edge).

MATERIALS AND METHODS

Thirty anterior lithium disilicate complete crowns (n=10 per finish line group) were fabricated by following a completely digital workflow based on digital scans made with the TRIOS scanner. The crowns were adhesively cemented on duplicate dies of the respective prepared Typodont teeth, and the marginal gap, absolute marginal discrepancy, and internal gap were evaluated by using microcomputed tomography (μCT). A total of 66 values were obtained for each specimen from sagittal and transaxial sections, and a rendering software program was used to calculate the volume of the cement gap for each specimen by means of 3D region growing. Two-way ANOVA, Tukey post hoc tests with Bonferroni correction, and the Kruskal-Wallis test were used to compare the values between the experimental groups (α=.05).

RESULTS

Marginal gap and absolute marginal discrepancy values were statistically significantly different between groups. In ascending order, marginal gap values were 23 ±14 μm for rounded shoulder, 54 ±28 μm for chamfer, and 96 ±36 μm for feather-edge finish lines. Absolute marginal discrepancy values were 96 ±34 μm for rounded shoulder, 124 ±37 μm for chamfer, and 157 ±34 μm for feather-edge finish lines. Internal gap values were 111 ±14 μm for feather-edge, 136 ±22 μm for chamfer, and 168 ±25 μm for rounded shoulder finish lines. The differences in cement volume between groups were not statistically significant (P=.200).

CONCLUSIONS

All 3 finish lines produced marginal gaps within the range of clinically accep table values. Lithium disilicate CAD crowns with a rounded shoulder finish line had the best marginal fit but the poorest internal fit, and lithium disilicate CAD crowns with a feather-edge finish line had the best internal fit but the poorest marginal fit.

Comparison of marginal and internal fit of pressed lithium disilicate veneers fabricated via a manual waxing technique versus a 3D printed technique

OBJECTIVE

The purpose of this in vitro study was to compare the marginal and internal fit of pressed lithium disilicate veneers fabricated from a 3D printed castable wax resin versus a manual waxing technique.

MATERIALS AND METHODS

A typodont model central incisor was prepared for a porcelain veneer. Following stone model fabrication from a polyvinyl siloxane impression, the model was digitized using a laboratory scanner. Group 1 veneers were designed digitally and 3D printed with a castable wax resin, then pressed. Group 2 veneers were fabricated using a manual wax and press approach. Veneers from both groups were bonded to printed dies. Following measurements of marginal adaptation under a stereo microscope, the dies were sectioned and measurements were made for internal adaption. Statistical analysis included a Kolmogorov test and a Mann-Whitney U test.

RESULTS

Average marginal gap (μm) for Group 1 was 40.37 ± 11.75 and 50.63 ± 16.99 for Group 2 (p = 0.51). Average internal gap (μm) for Group 1 was 61.21 ± 18.20 and 68.03 ± 14.07 for Group 2 (p = 0.178).

CONCLUSION

There was no difference in marginal fit or internal fit between pressed lithium disilicate veneers fabricated with a 3D printed castable resin and those fabricated with a manual waxing technique. The use of digital technologies and 3D printing provide significant advantages in the fabrication of pressed glass ceramic veneers, with marginal and internal adaptation comparable to manual wax and press techniques.

Marginal discrepancy and load to fracture of monolithic zirconia laminate veneers: The effect of preparation design and sintering protocol

To investigate and analyze the impact of teeth preparation designs and sintering protocol on marginal fit and fracture resistance of monolithic translucent zirconia laminate veneers. A total of 40 extracted intact human maxillary central incisors were assigned into 4 groups (n=10/each group) to investigate 2 variables: (1) the design of tooth preparation (a 1.5 mm incisal reduction with or without palatal chamfer) and (2) the two different sintering programs used for translucent zirconia restoration (standard or speed sintering procedure). Marginal discrepancy was evaluated using a digital microscope. The specimens were loaded to failure in the compression mode, using a universal testing machine with a crosshead speed of 0.5 mm/min. Marginal adaptation of monolithic translucent zirconia laminates are affected by both tooth preparation design and sintering protocol. However, resistance to fracture of translucent zirconia laminates has affected mainly by sintering procedure regardless the teeth preparation design used.