Marginal adaptation of CAD/CAM zirconia-based crown during fabrication steps

Marginal adaptation of different monolithic zirconia crowns with horizontal and vertical finish lines: A comparative in vitro study

Background

This study evaluated the influence of different tooth preparation techniques and zirconia materials on marginal adaptation.

Methods

Forty-eight healthy human maxillary first premolars were divided into two primary groups based on preparation design: group A (chamfer) and group B (vertical). Within each main group, there were three subgroups, comprising eight teeth each, distinguished by the type of zirconia material employed (Zircad LT, MT, and Prime by Ivoclar Vivadent). All the samples were prepared by the same operator using a dental surveyor. Intraoral scanning was performed on the prepared teeth. SironaInLab CAD 20.0 software was used to design crowns, which were subsequently generated using a 5-axis milling machine. The crowns were cemented to their respective teeth with self-adhesive resin cement. Marginal gap measurements were taken in micrometers (μm) before and after cementation at 16 sites per sample using a digital microscope at×230 magnification. The collected data were evaluated using statistical analysis using the independent t-test, paired t-test, and ANOVA at an 0.05 significance level.

Results

The vertical preparation group exhibited the smallest marginal gap, while the chamfer group displayed the largest. This disparity was statistically significant (P<0.05) for pre- and post-cementation measurements across all materials. There were no significant differences between the different monolithic zirconia crowns.

Conclusion

The vertical preparation design illustrated significantly better marginal adaptation than the chamfer preparation design. Comparisons between materials showed comparable marginal gaps. The mean values of the marginal gaps in all groups increased significantly after cementation.

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.

Does Resin Cement Type and Cement Preheating Influence the Marginal and Internal Fit of Lithium Disilicate Single Crowns?

This paper assesses the effect of cement type and cement preheating on the marginal and internal fit of lithium disilicate single crown. Methods: 40 maxillary premolars were selected, restored with lithium disilicate single crowns. Teeth were randomly assigned into four groups (n = 10) based on cement type (Panavia SA or LinkForce) and preheating temperature (25 °C or 54 °C). After fabrication of the restoration, cements were incubated at 25 °C or 54 °C for 24 h, and each crown was cemented to its corresponding tooth. After 24 h, all specimens were thermally aged to (10,000 thermal cycles between 5 °C and 55 °C), then load cycled for 240,000 cycles. Each specimen was then sectioned in bucco-palatal direction and inspected under a stereomicroscope at x45 magnification for marginal and internal fit evaluation. The data were statistically analyzed (significance at p ≤ 0.05 level). Results: At the mid-buccal finish line, mid-buccal wall, palatal cusp, mid-palatal wall, mid-palatal finish line, and palatal margin measuring points, there was a significant difference (p ≤ 0.05) between the lithium disilicate group cemented with Panavia SA at 25 °C and the group cemented with LinkForce at 25 °C, while there was no significant difference (p > 0.05) at the other points. At all measuring points, except at the palatal cusp tip (p = 0.948) and palatal margin (p = 0.103), there was a statistically significant difference (p ≤ 0.05) between the lithium disilicate group cemented with Panavia SA at 54 °C and the group cemented with LinkForce at 54 °C. Regardless of cement preheating, statistically significant differences were found in the buccal cusp tip, central groove, palatal cusp tip, and mid-palatal wall (p ≤ 0.05) in the lithium disilicate group cemented with Panavia SA at 25 °C and 54 °C, as well as the mid-palatal chamfer finish line and palatal margin in the LinkForce group cemented with Panavia SA at 25 °C and 54 °C. At the other measurement points, however, there was no significant difference (p > 0.05). Conclusions: The type of resin cement affects the internal and marginal fit of lithium disilicate crowns. At most measuring points, the cement preheating does not improve the internal and marginal fit of all lithium disilicate crowns.

Comparison of the internal fit of metal crowns fabricated by traditional casting, computer numerical control milling, and three-dimensional printing

This experimental study aimed to compare the internal fit (marginal fit and internal discrepancy) of metal crowns fabricated by traditional casting and digital methods (computer numerically controlled (CNC) milling and three-dimensional [3D] printing). Thirty standard master abutment models were fabricated using a 3D printing technique with digital software. Metal crowns were fabricated by traditional casting, CNC milling, and 3D printing. The silicon replica method was used to measure the marginal and internal fit. A thin layer of low-viscosity polyvinyl siloxane material was placed inside each crown and on the die (like a seat) until the material was set. Replicas were examined at four reference points under a microscope: the central pit (M1), cusp tip (M2), axial wall (M3), and margin (M4). The measured data were analyzed using a one-way analysis of variance (ANOVA) to verify statistical significance, which was set at p < 0.05. In the traditional casting group, the minimum distance measured was at M3 (90.68 ± 14.4 μm) and the maximum distance measured was at M1 (145.12 ± 22 μm). In the milling group, the minimum distance measured was at M3 (71.85 ± 23.69 μm) and the maximum distance measured was at M1 (108.68 ± 10.52 μm). In the 3D printing group, the minimum distance measured was at M3 (100.59 ± 9.26 μm) and the maximum distance measured was at M1 (122.33 ± 7.66 μm). The mean discrepancy for the traditional casting, CNC milling, and 3D printing groups was 120.20, 92.15, and 111.85 μm, respectively, showing significant differences (P < 0.05). All three methods of metal crown fabrication, that is, traditional casting, CNC milling, and 3D printing, had values within the clinically acceptable range. The marginal and internal fit of the crown was far superior in the CNC milling method.

The One-Year In Vivo Comparison of Lithium Disilicate and Zirconium Dioxide Inlays

The objective of the present study was to evaluate the one-year clinical performance of lithium disilicate (LD) and zirconium dioxide (ZrO₂) class II inlay restorations. Thirty healthy individuals who met the inclusion criteria were enrolled for the study. The patients were randomly divided into two study groups (n = 15): LD (IPS e.max press) and ZrO₂ (Dentcare Zirconia). In the ZrO₂ group, the internal surfaces of the inlays were sandblasted and silanized with Monobond N (Ivoclar, Leichsteistein, Germany). In the LD group, the internal surfaces of the inlays were etched with 5% hydrofluoric acid. The ceramic inlays were cemented with self-cure resin cement (Multilink N). Clinical examinations were performed using modified United State Public Health Codes and Criteria (USPHS) after 2 weeks, 4 weeks, 6 months and 1 year. The one-year survival rate was evaluated. In total, one failure was observed in the ZrO₂ group. The survival probability after 1 year for the ZrO₂ inlays was 93%, and for the LD inlays was 100%, which was statistically insignificant. The differences between both groups for most USPHS criteria (except for colour match) were statistically insignificant. Within the imitations of the present study, the lithium disilicate- and zirconia dioxide-based inlays exhibited comparable clinical performances. However, the colour and translucency match was superior for the lithium disilicate restorations.

Digital evaluation of absolute marginal discrepancy: A comparison of ceramic crowns fabricated with conventional and digital techniques

STATEMENT OF PROBLEM

Marginal discrepancy is key to evaluating the accuracy of fixed dental prostheses. An improved method of evaluating marginal discrepancy is needed.

PURPOSE

The purpose of this in vitro study was to evaluate the absolute marginal discrepancy of ceramic crowns fabricated using conventional and digital methods with a digital method for the quantitative evaluation of absolute marginal discrepancy. The novel method was based on 3-dimensional scanning, iterative closest point registration techniques, and reverse engineering theory.

MATERIAL AND METHODS

Six standard tooth preparations for the right maxillary central incisor, right maxillary second premolar, right maxillary second molar, left mandibular lateral incisor, left mandibular first premolar, and left mandibular first molar were selected. Ten conventional ceramic crowns and 10 CEREC crowns were fabricated for each tooth preparation. A dental cast scanner was used to obtain 3-dimensional data of the preparations and ceramic crowns, and the data were compared with the "virtual seating" iterative closest point technique. Reverse engineering software used edge sharpening and other functional modules to extract the margins of the preparations and crowns. Finally, quantitative evaluation of the absolute marginal discrepancy of the ceramic crowns was obtained from the 2-dimensional cross-sectional straight-line distance between points on the margin of the ceramic crowns and the standard preparations based on the circumferential function module along the long axis.

RESULTS

The absolute marginal discrepancy of the ceramic crowns fabricated using conventional methods was 115 ±15.2 μm, and 110 ±14.3 μm for those fabricated using the digital technique was. ANOVA showed no statistical difference between the 2 methods or among ceramic crowns for different teeth (P>.05).

CONCLUSIONS

The digital quantitative evaluation method for the absolute marginal discrepancy of ceramic crowns was established. The evaluations determined that the absolute marginal discrepancies were within a clinically acceptable range. This method is acceptable for the digital evaluation of the accuracy of complete crowns.

The effect of veneering on the marginal fit of CAD/CAM-generated, copy-milled, and cast metal copings

OBJECTIVE

This in vitro study investigated the marginal fit of metal and zirconia copings before and after veneering on dies with shoulder/chamfer (s/c) finish lines.

MATERIALS AND METHODS

Using CAD/CAM, ten (n = 10) each s/c zirconia (NZ) copings and ten (n = 10) each s/c metal (MM) copings were generated. As controls, ten (n = 10) each s/c zirconia copings were copy-milled (ZZ) and ten (n = 10) each s/c metal copings were cast (CC). The vertical marginal discrepancy of the copings was measured at 20 predefined spots of the circular shoulder and chamfer finish lines in microns (μm) before and after a first and a second veneering firing using a stereomicroscope at ×40 magnification. Data were statistically analyzed, and the comparisons of CAD/CAM-milled (NZ, MM), copy-milled (ZZ), and cast (CC) copings before and after veneering were made at a significance level of p < 0.05.

RESULTS

Gap width at s/c finish lines of ZZ was (91 ± 11/100 ± 28) and increased significantly (109 ± 21/141 ± 18) after the first firing (ZZ1). NZ showed significantly smaller gaps than ZZ (36 ± 6/46 ± 12) and (NZ1) after the first firing (61 ± 16/71 ± 29). Gap widths of CC groups (36 ± 8/25 ± 4) were not significantly different from NZ but were significantly lower after the (CC1) first veneering firing (40 ± 8/42 ± 7). MM copings showed gap values similar to NZ. Second firings did not significantly increase gaps in all groups except ZZ2 of chamfer finish line.

CONCLUSION

Veneering increased the marginal gap width of copings.

CLINICAL RELEVANCE

Within the limits of this in vitro study, aesthetic ceramic veneering of CAD/CAM-generated copings caused a statistically significant but tolerable loss of marginal fit precision.