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

Evaluation of stress distribution of different marginal designs on PEEK and PEKK substructure materials, cortical and cancellous Bone:A finite element analysis

BACKGROUND

High-performance polymers are used in different fixed prosthesis treatments due to their many advantages such as biocompatibility, shock absorption ability, high fracture resistance. The effects of marginal design on the forces on high-performance polymers are unknown. This study aimed was to investigate the stress distribution of different marginal designs on Polyetheretherketone (PEEK) and Polyetherketoneketone (PEKK) substructure materials, cortical bone and cancellous bone by finite element analysis.

METHODS

A first maxillary molar tooth was modeled in 3D using the "3D Complex Render" method. Considering the ideal preparation conditions (Taper angle was 6°, step depth was 1 mm, occlusal reduction was 2 mm), four different configurations were modeled by changing the marginal design (chamfer, deep chamfer, shoulder 90°, shoulder 135°). PEEK, PEKK substructure, and composite superstructure were designed on created models. A total of 150 N oblique force from two points and a total of 300 N vertical force from three points were applied from occlusall. and the maximum principal stress, minimum principal stress, von Mises stress findings in the cortical bone, spongiose bone, and substructure were examined. The study was carried out by static linear analysis with a three-dimensional finite element stress analysis method.

RESULTS

The highest maximum principal stress value in the cortical bone was observed when the PEEK + Shoulder 135° step at vertical force. The highest minimum principal stress value in the cortical bone was observed when the PEEK + Shoulder 90° step, and PEEK + deep chamfer step at oblique force. The highest maximum principal stress value in spongiose bone was observed when the PEEK + Shoulder 90° step. The highest minimum principal stress value in spongiose bone was observed when the PEEK + deep chamfer step at vertical force. The highest von Mises stress value in the substructure was observed when the PEKK + Deep chamfer step at oblique force. The lowest maximum principal stress value in the cortical bone was observed when the PEKK + Shoulder 135° step at oblique force. The lowest minimum principal stress value in the cortical bone was observed when the PEEK + Shoulder 135° step, and PEKK + shoulder 135° step at vertical force. The lowest maximum principal stress value in spongiose bone was observed when the PEEK + Shoulder 90° step. The lowest minimum principal stress value in spongiose bone was observed when the PEEK + Shoulder 135° step and PEKK + Shoulder 135° step at vertical force. The lowest von Mises stress value in the substructure was observed when the PEEK + Deep chamfer step at vertical force.

CONCLUSION

When cortical and spongiose bone stress were evaluated, no destructive stress was observed. Considering the stresses occurring in the substructure the highest stress was observed in the chamfer step.

Three Self-Adhesive Resin Cements and Their Influence on the Marginal Adaptation of Zirconia-Reinforced Lithium Silicate Single Crowns: An In Vitro Scanning Electron Microscope Evaluation

Background: In everyday dentistry, monolithic single crowns can be cemented with self-adhesive resin cements. The aim of this in vitro study was to evaluate how the marginal adaptation of full monolithic zirconia-reinforced lithium silicate (ZLS) single crowns is influenced by three different self-adhesive resin cements. Methods: Forty-five typodont teeth fully prepared for full monolithic crowns were divided into three groups (fifteen each) for the use of three different self-adhesive resin cements. A fourth control group (Temp-bond) was created by taking five teeth from each group before cementation with self-adhesive resin cements. All forty-five abutments were scanned using a Primescan intra-oral scanner (IOS), followed by computer-aided design (CAD) and computer-aided manufacturing (CAM) of zirconia-reinforced lithium silicate (ZLS) full crowns using a four-axis machine. Initially, the crowns of the control group were fixed to the abutments using Temp-bond, and the marginal gap was evaluated using a scanning electron microscope (SEM). After removing the control group crowns from the abutments, fifteen crowns in each group were cemented using a different self-adhesive resin cement and observed under SEM for evaluation of the marginal gap. A Kolmogorov-Smirnov test was performed, indicating no normal distribution (p < 0.05), followed by Mann-Whitney tests (α = 0.05). Results: The total mean marginal gap of the temp-bond control group was significantly lower compared to all three groups of self-adhesive resin cement (p < 0.0005). The total mean marginal gap of the G-cem ONE group was significantly lower compared to the TheraCem group (p < 0.026) and RelyX U200 group (p < 0.008). The total mean marginal gap of the TheraCem group was significantly higher than the G-cem ONE group (p < 0.026) but showed no significant difference with the RelyX U200 group (p > 0.110). Conclusions: All four groups showed a clinically acceptable marginal gap (<120 microns). Although all three groups of self-adhesive resin cement showed a significant increase in the marginal gap compared to the temp-bond control group, they were within the limits of clinical acceptability. Regarding the marginal gap, in everyday dentistry, it is acceptable to use all three self-adhesive resin cements, although the G-cem ONE group exhibited the lowest marginal gap for ZLS single crowns.

Influence of thermal aging on the marginal integrity of computer aided design/computer aided manufacturing fabricated crowns

Background/purpose

The adaptation and marginal integrity of computer-aided designed and computer-aided manufactured (CAD/CAM) crowns after exposure to thermal aging need to be investigated. The present in-vitro study was designed to investigate the marginal integrity of CAD/CAM fabricated crowns cemented on extracted teeth after thermocycling aging.

Materials and methods

Twenty-six newly extracted human premolars were prepared for full-coverage CAD/CAM crowns and were divided into two groups (leucite-reinforced glass-ceramics and lithium disilicate glass-ceramics). Both crowns' groups were cemented using dual curing resin cement. All specimen margins were measured for marginal integrity using an imaging system 24 h post cementation; then after 1, 3, and 5 estimated clinical years (10,000, 30,000, and 50,000 thermocycles). Two-way ANOVA analysis were used to determine whether the mean value difference is significantly different (ɑ = 0.05).

Results

The average margin gaps recorded for leucite-reinforced glass-ceramic crowns were: 82.61 μm initial, and 91.02 μm after 5 estimated clinical year). For the lithium disilicate glass-ceramic crowns, the average margin gaps recorded were: 100.01 μm initial, and 120.21 μm after 5 estimated clinical year. During all measuring intervals, the leucite-reinforced glass-ceramic crown group had a lower marginal discrepancy. No statistically significant difference between the two groups was recorded.

Conclusion

After being subjected to thermocycling, both CAD/CAM ceramic crowns, exhibited an increase in their marginal discrepancy; the difference was within the accepted clinical range.

Comparison of loupes versus microscope-enhanced CAD-CAM crown preparations: A microcomputed tomography analysis of marginal gaps

STATEMENT OF PROBLEM

Long-term restoration success depends on a precision marginal fit to prevent marginal leakage and caries. The successful fit of a computer-aided design and computer-aided manufactured (CAD-CAM) crown may be affected by different workflow variables, including preparation, scanning, crown design, milling, sintering, and cementation. Discrepancies in any of these steps may result in poor marginal and internal fit. Evidence suggests that tooth preparation may be the most important step in the workflow for a successful outcome. Compared with the traditional means of crown preparation using the naked eye or loupes, the dental operating microscope provides higher magnification and more direct illumination. However, the impact of high magnification during preparation on the marginal quality of CAD-CAM crowns is unclear.

PURPOSE

The purpose of this in vitro study was to compare marginal fits of CAD-CAM crowns fabricated after initial preparation with loupes and subsequent preparation refinement with either loupes or a microscope. The null hypothesis was that no significant difference would be found in the marginal gap between the preparations with loupes and those with a microscope.

MATERIAL AND METHODS

Mounted extracted molars (N=18) received initial crown preparations with a coarse grit, rounded shoulder, diamond rotary instrument with loupes of ×3.0 magnification. The teeth were then randomly divided into 2 groups and refined for an additional 2 minutes with fine grit, rounded shoulder, diamond rotary instruments with either loupes (LOUP) or a microscope up to ×10.0 magnification (DOM). The prepared teeth were scanned with an intraoral scanner to fabricate zirconia-reinforced lithium silicate crowns manufactured with a 4-axis milling machine, sintered in a dental furnace in accordance with the manufacturer's instructions, and cemented with self-adhesive resin cement. All teeth with crowns were mounted and scanned with a microcomputed tomography (μCT) system at 21-μm nominal voxel size. The resulting Digital Imaging and Communications in Medicine (DICOM) images were imported into a semiautomatic segmentation software program. Marginal and absolute gaps were measured at 24 consistent circumferential points per specimen. Absolute gaps were labeled, and the total volume was calculated. Paired and unpaired t tests were used for statistical analysis (α=.05).

RESULTS

The mean marginal gap was 145.0 ±259.6 μm for LOUP and 35.6 ±110.6 μm for DOM, with a statistically significant difference (P<.001). The mean gap volume for LOUP was 0.975 ±0.811 mm3, and 0.250 ±0.477 mm3 for DOM, also statistically significantly different (P=.023). A significant difference was found between the absolute and marginal gaps for LOUP (P=.007), but for DOM, the difference was not significant (P=.063).

CONCLUSIONS

This study demonstrated that the higher magnification used during tooth preparation played a significant role in the size of marginal gaps present around CAD-CAM crowns. Crown preparations finished by using fine grit diamond rotary instruments with a microscope at higher magnification than loupes resulted in a more precise marginal fit with smaller gaps.

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.

Effects of design software program and manufacturing method on the marginal and internal adaptation of esthetic crowns for primary teeth: A microcomputed tomography evaluation

STATEMENT OF PROBLEM

The adaptation of digitally produced crowns is affected by the design software program and manufacturing method. The effect of artificial intelligence (AI) software program design on the adaptation of the crowns is unclear and comparative evaluations should be documented.

PURPOSE

The purpose of this study was to assess the marginal and internal gaps, the absolute marginal discrepancies, and the 3-dimensional (3D) discrepancy volumes of the resin-based milled and 3D printed crowns for primary teeth designed with computer-aided design (CAD) and AI software programs by using microcomputed tomography (µCT).

MATERIAL AND METHODS

A total of 40 resin-based esthetic crowns were produced for a prepared typodont tooth (right mandibular primary second molar) according to the design software program (CAD and AI) and manufacturing method (milling and 3D printing) (n=10). Four experimental groups were generated as CAD-milled, CAD-3D printed, AI-milled, and AI-3D printed. The marginal, axial, and occlusal gap values, the absolute marginal discrepancies, and the 3D discrepancy volumes of the specimens were measured by using µCT. The data were analyzed by using 2-way ANOVA and the Tukey HSD tests (α=.05).

RESULTS

The lowest value for the marginal gap (54 ±43 µm) was observed in the CAD-milled group and the marginal gap value of the AI-3D printed group was significantly lower than the AI-milled group (P<.05). The lowest value for the axial gap (63 ±7 µm) was observed in the AI-3D printed group, and the highest value (145 ±58 µm) was observed in the CAD-milled group; the result for the occlusal gap value was opposite. The highest absolute marginal discrepancy value was observed in the CAD-milled group. The 3D discrepancy volumes increased in the order of the CAD-3D printed, AI-milled, CAD-milled, and AI-3D printed groups.

CONCLUSIONS

The marginal and internal gap values of the resin-based crowns were affected by the design software program and manufacturing method; however, tested groups showed clinically acceptable gap values.

Fit and fatigue behavior of CAD-CAM lithium disilicate crowns

STATEMENT OF PROBLEM

New computer-aided design and computer-aided manufacturing (CAD-CAM) lithium disilicate glass-ceramics have been marketed. However, information concerning their biomechanical behavior is lacking.

PURPOSE

The purpose of this in vitro study was to compare the fit and fatigue behavior of two recently introduced CAD-CAM lithium disilicate materials with the standard IPS e.max CAD ceramic and to investigate the effect of the thermal treatment for crystallization on crown fit.

MATERIAL AND METHODS

Monolithic crowns (n=15) were milled from 3 CAD-CAM lithium disilicates: IPS e.max CAD (Ivoclar AG), Rosetta SM (Hass), and T-lithium (Shenzhen Upcera Dental Technology). Marginal and internal fit were evaluated using the replica technique before and after crystallization, and the fatigue behavior of the luted crowns was evaluated by the step-stress method. One-way ANOVA and the Tukey test were used to compare fit among the materials. Fatigue failure load was evaluated by the Kaplan-Meier and Mantel-Cox tests. The effect of crystallization on fit was evaluated with the paired t test (α=.05).

RESULTS

Marginal fit was different between IPS e.max CAD (74 μm) and Rosetta SM (63 μm) (P=.02). T-lithium was similar to the other ceramics (68 μm) (P>.05). Occlusal internal space was similar among all materials (P=.69). Fatigue failure loads of Rosetta SM (1160 N) and T-lithium (1063 N) were similar to IPS e.max CAD (1082 N) (P>.05). The fatigue failure load of Rosetta SM was higher than that of T-lithium (P=.04). Crystallization reduced the axial internal space of all materials (P<.05) without significantly affecting marginal fit (P>.05).

CONCLUSIONS

The fit and fatigue behavior of Rosetta SM and T-lithium were similar to that of IPS e.max CAD. Crystallization reduced the internal space of the crowns.

A micro-computed tomography analysis of internal and marginal fits of fixed partial dentures: Effect of preparation finish line designs on monolithic zirconia and heat-pressed zirconia-reinforced lithium disilicate

PURPOSE

To evaluate the effect of finish line design (chamfer and feather-edge) and ceramic type on the internal and marginal fits of fixed partial dentures on abutment teeth.

MATERIALS AND METHODS

Two typodont mandibular casts, missing right first premolar tooth, received tooth preparation on canine and second premolar abutments (one cast with chamfer finish line and the other cast with feather-edge finish line). The preparation segment of each typodont model was scanned, 3D printed in resin, and then invested and casted in metal to obtain two metal models. Polyvinyl siloxane impressions were made for the metal models and poured in type IV stone. The stone models (n = 40) were randomly assigned into four groups (n = 10): chamfer finish line with heat-pressed zirconia reinforced lithium disilicate fixed partial denture (CL), chamfer finish line with monolithic zirconia fixed partial denture (CZ), feather-edge finish line with heat-pressed zirconia-reinforced lithium disilicate fixed partial denture (FL), and feather-edge finish line with monolithic zirconia fixed partial denture (FZ). After the fabrication of ceramic restoration, micro-computed tomography was used to evaluate the internal and marginal fits of each fixed partial denture. Data were statistically analyzed with three-way ANOVA (α = 0.05).

RESULTS

There were no significant interactions between preparation type, material type, and tooth type at any of the areas assessed. There was significant difference (p = 0.01) between CZ (59.15 ± 4.6 µm) and FZ (73.6 ± 17.1 µm) groups at the finish line area. Regarding the horizontal marginal discrepancy area, there were significant differences between CZ (62.65 ± 10.5 µm) and FZ (90.05 ± 5.6 µm) groups (p < 0.001), CL (77.45 ± 8.1 µm) and CZ (62.65 ± 10.5 µm) groups (p < 0.001), and FZ (90.05 ± 5.6 µm) and CL (77.45 ± 8.1 µm) groups (p < 0.001). At finish line area, there was a significant difference (p = 0.018) between feather-edge with canine (72.75 ± 13.3 µm) and chamfer with canine (59.05 ± 5.8 µm); however, there was no significant difference (p = 0.774) between feather-edge with premolar (69.45 ± 12 µm) and chamfer with premolar (65.1 ± 7.4 µm). Moreover, there was no significant difference (p = 0.886) between feather-edge with canine and feather-edge with premolar.

CONCLUSIONS

The internal and marginal fits of the ceramic fixed partial dentures can be affected by the finish line design and ceramic type. The feather-edge finish line had a negative impact on the marginal and internal fits of ceramic fixed partial dentures at certain measurement points. Regarding the effect of finish line design on abutment teeth, the difference in fit was only detected at the finish line area of the anterior abutment (canine) with the feather-edge finish line.

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.

Fit accuracy of resin crown on a dental model fabricated using fused deposition modeling 3D printing and a polylactic acid filament

Purpose We considered the possibility of reducing industrial waste by fabricating and reusing dental models prepared using a fused deposition modeling (FDM) 3D printer and polylactic acid (PLA) filaments. The purpose of this study was to verify the accuracy of models fabricated using FDM and PLA.Methods The same provisional crown was used to check the marginal fit on PLA models prepared using an intraoral scanner (IOS) and FDM, plaster models made with silicone impression material and plaster, and resin models prepared using an IOS and stereolithography apparatus (SLA) 3D printer. The marginal fit was measured using micro-computed tomography at four points on the tooth: the buccal center (B), palatal center (P), mesial center (M), and distal center (D) points.Results At point B, the marginal gaps were 118 ± 21.7, 62 ± 16.4, and 50 ± 26.5 μm for the PLA, resin, and plaster models, respectively, with a significant difference between the PLA model and the other two. However, the marginal gap at all other measurement points was not significantly different between the models (P > 0.05).Conclusions We compared the accuracy of the models fabricated using the FDM, SLA, and conventional methods. The combination of FDM and PLA filaments showed no significant differences from the other models, except at point B, indicating its usefulness. Therefore, FDM and PLA may become necessary materials for dental treatment in the future.

Effect of abutment finish lines on the mechanical behavior and marginal fit of screw-retained implant crowns: An in vitro study

STATEMENT OF PROBLEM

The design of the implant-abutment connection has been widely researched, but the impact of different crown-abutment geometries remains unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of different crown-abutment margin geometries on the mechanical behavior and fit of screw-retained implant-supported single-crown restorations by using mechanical static and fatigue tests and mastication simulation.

MATERIAL AND METHODS

A total of 45 cobalt-chromium premolar-shaped metal frameworks were fabricated for single-unit implant-supported screw-retained restorations on stock abutments and internal hexagon Ø4.25×11-mm cylindrical implants. They were divided into 3 groups according to margin geometry: S, shoulder; C, chamfer; and F, feather-edge. Three static load until fracture and 24 dynamic load tests were performed by using the International Organization for Standardization 14801:2016 standard (ISO 14801:2016) (number of cycles limit: 5×10⁶ cycles, frequency: 6 Hz). The ProFatigue software program was used to optimize the procedure (S, n=12 specimens; C, n=7 specimens; and F, n=5 specimens). Six additional specimens from each group were subjected to a mastication simulation (limit number of cycles: 1×10⁶ cycles, cyclic loading from P_min=30 N to P_max=300 N, frequency: 6 Hz). Results from the fatigue tests were reported descriptively, and the Fisher exact test was used to analyze the difference in failure modes. Data from maximum misfit were evaluated by photogrammetry and statistically analyzed with the Anderson-Darling test and the Kruskal-Wallis and Dunn multiple comparison tests (α=.05).

RESULTS

The fatigue limit was 456 N for group S, 512 N for group C, and 514 N for group F. The mean ±standard deviation misfit was 2.6 ±0.1 μm for group S, 3.8 ±1.1 μm for group C, and 3.6 ±0.8 μm for group F. Differences in misfit between groups S and C and between groups S and F were statistically significant (P<.05).

CONCLUSIONS

Crown-abutment connections with chamfer and feather-edge margins showed better mechanical behavior, while shoulder margin exhibited better fit. However, high levels of fit were achieved for all the evaluated geometries.

Effect of Biologically Oriented Preparation Technique on the Stress Concentration of Endodontically Treated Upper Central Incisor Restored with Zirconia Crown: 3D-FEA

The aim of this study was to evaluate the effect of biologically oriented preparation technique on the stress concentration of endodontically treated upper central incisors restored with zirconia crown (yttria-stabilized zirconia polycrystalline ceramic) through finite element analysis (FEA). Four models of maxillary central incisors containing enamel, dentin, periodontal ligament, cortical and medullary bone were created in CAD. Each model received a polymeric core-build up with nanofilled dental resin composite. The evaluated models were SM-preparation in shoulder 90°; CM-chamfer preparation; BOPT-biologically oriented preparation technique and BOPTB-BOPT preparation 1 mm below the cement-enamel junction. All models received zirconia crowns (5Y-TZP), fiberglass post and 1 mm ferrule. The models were imported into the analysis software with parameters for mechanical structural testing using the maximum principal stress and the tensile strength as the analysis criteria. Then, load of 150 N was applied at the cingulum with 45° slope to the long axis of the tooth, with the fixed base for each model. The type of marginal preparation affected the stresses concentration in endodontically treated teeth and in the zirconia crown margin. Considering the stress magnitude only, BOPT is a viable option for anterior monolithic zirconia crowns; however, with the highest stress magnitude at the restoration margin.