Fracture resistance of cingulum rest seats in CAD-CAM tooth-colored crowns for removable partial denture abutments

Fracture Resistance of Zirconia Surveyed Crowns With Digitally Designed and Hand-Modified Occlusal Rest Seats

Background In light of the trend of using zirconia crowns, clinicians will likely face abutment included in removable partial dentures (RPD) designs with existing zirconia. However, the decision to replace the existing crown with a surveyed crown or modify the existing crown to accept the RPD is unclear. To the best of our knowledge, there is a lack of literature on the effect of preparing a rest seat on the existing monolithic zirconia crown in the patient's mouth on the fracture resistance of the crown. Therefore, in this study, we aimed to evaluate the fracture resistance of computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia surveyed crowns with digitally designed rest seats and hand-modified rest seats. Methods Thirty CAD/CAM zirconia surveyed crowns were digitally designed and fabricated and divided into groups (n=10 per group) as follows: Group 1 comprised surveyed crowns with no occlusal rest seat; Group 2 comprised surveyed crowns with a digitally designed mesial rest seat; and Group 3 comprised surveyed crowns with a hand-modified mesial rest seat. Then, with all the crowns cemented to metal dies, the specimens were subjected to a fracture resistance test using a universal testing machine (Model 8501 Instron, Norwood, MA, USA). Results Surveyed crowns without any rest seat and those with digitally created and hand-modified rest seats displayed different fracture resistances: crowns with no rest seat offered the highest fracture resistance (5831 ± 895.15 N), followed by those with a digitally designed and milled rest seat (5280 ± 1673.33 N). Crowns with a hand-modified rest seat provided the lowest fracture resistance (4976 ± 322.5 N). Based on our results, surveyed crowns without a rest seat displayed higher fracture resistance than those with a rest seat. Conclusion The fracture resistance of crowns with a digitally designed and milled rest seat was statistically similar to that of control crowns with no rest seat, whereas hand-modified rest seats significantly reduced the fracture resistance of surveyed zirconia crowns.

Fracture resistance of CAD-CAM all-ceramic surveyed crowns with different occlusal rest seat designs

PURPOSE

To investigate the fracture resistance of monolithic CAD-CAM all-ceramic surveyed crowns with two different occlusal rest seat designs.

MATERIALS AND METHODS

Two maxillary first premolar were prepared for all-ceramic surveyed crowns with wide (2/3^rd of buccolingual width of an unprepared tooth) or narrow (1/3^rd of buccolingual width of an unprepared tooth) disto-occlusal rest seat (ORS) designs. Eighty monolithic CAD-CAM all-ceramic surveyed crowns were prepared and divided into 4 groups - Group CR, Composite resin material as a control; Group LDS, Lithium disilicate based material; Group ZIPS, zirconia-material (IPS ZirCAD); and Group ZLHT, zirconia- material (CeramillZolidht+). Crowns were cemented on an epoxy resin die with adhesive resin cement. The fracture resistance of crowns was tested with the universal machine. Univariate regression analysis was used.

RESULTS

The mean ± standard deviation of maximum failure force values varied from 3476.10 ± 285.97 N for the narrow ORS subgroup of group ZIPS to 687.89 ± 167.63 N for the wide ORS subgroup of group CR. The mean ± standard deviation of maximum force was 1075 ± 77.0 N for group CR, 1309.3 ± 283.9 N for group LDS, 3476.1 ± 285.97 N for group ZIPS, and 2666.7 ± 228.21 N for group ZLHT, with narrow occlusal rest seat design. The results of the intergroup comparison showed significant differences in fracture strength with various material groups and occlusal rest seat designs (P <.001).

CONCLUSION

The zirconia-based all-ceramic surveyed crowns fractured at more than double the load of Lithium disilicate based crowns. The crowns with narrow base occlusal rest seat design had statistically significantly higher fracture resistance than surveyed crowns with wide occlusal rest seat design. The use of narrow occlusal rest seat design in CAD-CAM all ceramic surveyed crowns provides higher fracture resistance, and therefore narrow occlusal rest design can be used for providing esthetics with high strength.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.

Fabricating a crown under an existing removable partial denture with impression scanning and CAD-CAM technology

Retrofitting a new crown to an existing removable partial denture (RPD) is a challenging procedure. Recently, intraoral scanners (IOSs) have been successfully used to solve this issue. However, purchase of IOSs is necessary, and most clinicians still use the conventional impression technique. This article describes a combined conventional and digital approach to fabricating a new crown under an RPD without an IOS.