Marginal adaptation of three different zirconium dioxide three-unit fixed dental prostheses

The influence of pontic distribution on the marginal and internal gaps of CAD/CAM five-unit anterior zirconia framework

Background/purpose

Nowadays, zirconia-based framework has been used for longspan or full-arch fixed dental prostheses (FDPs). This study aimed to evaluate the effect of pontic distribution on marginal and internal gaps of five-unit anterior zirconiabased DPs.

Materials and methods

Right maxillary central incisor and second premolar were selected as terminal abutments and three different edentulous conditions with one nonterminal abutment were simulated. Marginal and internal gaps in each zirconia-based samples(n = 10) were examined by computer-aided replica technique. Five regions, including marginal gaps at mesial or distal finishing line, internal gaps at the mesial or distal axial wall, and occlusal surface, were statistically analyzed (α = .05).

Results

Most of marginal gaps and internal gaps at axial wall were clinically acceptable, but larger at occlusal surface. For the three experimental groups, clinically accepted percentage with qualified gaps were less than 30%.There were statistical differences at axial wall over pontic side and marginal gaps over non-pontic side between groups (P<0.05). For sum of gaps of all abutments in each group, statistical differences were found at marginal and axial wall (P < 0.05). As for those on terminal and non-terminal abutments, statistical differences were found on second premolar (P < 0.05).

Conclusion

Except for occlusal surface, the overall marginal gaps and internal gaps at axial wall of five-unit anterior zirconia-based FDPs with different pontic distribution were clinically acceptable. However, the percentage with qualified gaps were low (<30%). Greater gaps were noted when adjacent pontic existed. Different pontic size and distribution with curvature had an influence on the gaps.

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.

Evaluation of Marginal and Internal Adaptation of Crowns Fabricated with Three Different Zirconia CAD/CAM Materials

BACKGROUND

Marginal and internal adaptation are key factors that determine the clinical success of dental restorations.

AIM

The aim of this study is to evaluate the marginal and internal fit of crowns fabricated with three different CAD-CAM zirconia materials; two monolithic zirconia materials and one veneered zirconia copings in comparison with conventional metal-ceramic crowns.

MATERIAL AND METHODS

Ninety-six extracted molars (n = 96) were selected. Teeth were randomly divided into four groups (n = 24), and the following restorations were fabricated: Metal-ceramic crowns (Control group) (Group CG); monolithic zirconia crowns (GC initial) (Group MZ1); monolithic zirconia crowns (InCoris TZI),(Group MZ2); bilayered zirconia crowns, cores (InCoris ZI) veneered with a low-fusing glass-ceramic (IPS Emax Ceram),(Group BZ). Internal and marginal adaptations were evaluated using the silicone replica technique. A total of 20 points were recorded for every tooth under the light microscope at 20x magnifications. Results were compared using one-way analysis of variance (ANOVA) and the posthoc Tukey's test at a significance level of 0.01.

RESULTS

Marginal, marginal-internal, axial, and occlusal gaps between CG, MZ1, MZ2, and BZ crowns showed statistically significant differences (P < 0.01).

CONCLUSION

Monolithic zirconia groups showed better marginal adaptation compared with the veneered zirconia crowns.

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.

Performance of direct and indirect onlay restorations for structurally compromised teeth

STATEMENT OF PROBLEM

Research is lacking on the restoration of structurally compromised posterior teeth using direct composite resin or indirect restorations.

PURPOSE

The purpose of this in vitro study was to measure the fracture resistance and microleakage of different onlay restorations fabricated by using conventional and digital computer-aided design and computer-aided manufacturing (CAD-CAM) to restore structurally compromised teeth.

MATERIAL AND METHODS

Mandibular molars (n=54) were prepared for onlay restorations. Teeth were allocated to 3 groups (n=18) according to the type of restoration materials, nanohybrid composite resin (Grandio blocs), resin hybrid ceramic (SHOFU Block HC), and fiber-reinforced composite resin (everX Posterior). Onlays were bonded using a dual-polymerized adhesive resin cement. All specimens were thermocycled, followed by cyclic loading. Based on the type of investigation conducted, fracture resistance, and microleakage test, each group was then divided into 2 equal subgroups (n=9). The collected data were statistically analyzed with the chi-square of the Fischer exact test (α=.05).

RESULTS

Fracture resistance testing revealed a statistically significant difference between groups (P<.001). The fiber-reinforced composite resin demonstrated the highest fracture resistance, with statistically significantly less microleakage compared with the other groups (P=.013).

CONCLUSIONS

Direct fiber-reinforced composite resin could be considered a suitable alternative to CAD-CAM composite resin for the restoration of structurally compromised teeth.

Effect of coping materials zirconia or polyetheretherketone with different techniques of fabrication on vertical marginal gap and fracture resistance of posterior crowns with composite veneering

BACKGROUND

Insufficient research has been conducted in the literature assessing the performance of zirconia and polyetheretherketone (PEEK) crowns in relation to the essential requirements of successful restorations, such as fracture resistance or margin adaptation. The purpose of this study was to evaluate the effect of the coping materials zirconia or PEEK with different fabrication techniques on the vertical marginal gap and fracture resistance of posterior crowns with composite veneering.

METHODS

Ceramic copings (n = 18) restoring mandibular first molar were fabricated from zirconia (Zircon.x, Presidentdental, Germany), milled PEEK (PEEK CAD) (breCAM.BioHPP, Bredent, Germany) and pressed PEEK (PEEK Press) (BioHPP Granules, Bredent, Germany) six specimens each (n = 6). The copings were veneered with high impact polymer composite (HIPC) material (breCAM.HIPC, Bredent, Germany). The vertical marginal gap was captured under a magnification of 40X. Five equidistant marks on each surface of the die distinguished the points of measurement for a total of 20 readings per sample. The analysis was completed using an image analysis system (ImageJ 1.53t, National Institute of Health, USA). The specimens were loaded to failure at a crosshead speed of 1 mm/min and the load at failure was recorded to measure the fracture resistance.

RESULTS

The marginal gap was analyzed using one-way ANOVA followed by Tukey's post hoc test. Fracture resistance was analyzed using Welch one-way ANOVA followed by the Games-Howell post hoc test. Marginal gap values showed a significant difference between the tested groups, with zirconia having significantly lower gap values (48.67 ± 11.98 µm) than both the PEEK CAD (108.00 ± 20.08 µm) and Press groups (108.00 ± 25.10 µm) (p < 0.001). However, the results of fracture resistance showed no significant difference (p = 0.06) with 1687.47 ± 253.29 N, 2156.82 ± 407.64 N, 2436.72 ± 725.93 N for zirconia, PEEK CAD, and Press, respectively. The significance level was p < 0.05.

CONCLUSIONS

Zirconia framework crowns have a smaller vertical marginal gap than milled and pressed PEEK crowns. Crowns fabricated from zirconia, PEEK CAD, or PEEK Press frameworks and veneered with composite resin have comparable fracture resistance lower than the maximum biting force in the posterior region.

CLINICAL RELEVANCE

Posterior crowns with zirconia frameworks are preferred over milled and pressed PEEK frameworks regarding margin adaptation, although all can safely survive the maximum occlusal forces without fracture.

Micro-CT analysis of marginal and internal fit of milled and pressed polyetheretherketone single crowns

STATEMENT OF PROBLEM

Polyetheretherketone (PEEK) has been increasingly used as a framework material in prosthetic dentistry. However, data on the marginal and internal fit of PEEK restorations fabricated by using either the computer-aided design and computer-aided manufacturing (CAD-CAM) or heat-pressing technique are sparse.

PURPOSE

The aim of this in vitro study was to assess the marginal and internal fit of milled and pressed PEEK single crowns by using microcomputed tomography (μCT).

MATERIAL AND METHODS

A custom-made, single stainless-steel die was designed to replicate a maxillary first premolar prepared for a ceramic crown. PEEK copings (N=30) were fabricated and allocated to 3 groups (n=10) according to the fabrication technique: milled from a prefabricated PEEK blank, heat pressed from PEEK pellets, and heat pressed from PEEK granules. All copings were veneered with a composite resin material. The marginal fit was recorded at 4 predetermined points and the internal fit at 8 predetermined points on each crown by using μCT. Two-way ANOVA, pair-wise Tukey honestly significant difference (HSD), and simple main effect tests were used for statistical analysis of the data (α=.05).

RESULTS

Concerning marginal fit, the milled crowns demonstrated the best marginal fit overall (44 ±3 μm), followed by those pressed from pellets (92 ±3 μm), and finally by those pressed from granules (137 ±7 μm) (P<.001). The interaction between the effects of the fabrication technique and the measurement point on the marginal fit was not statistically significant (P=.142). The milled crowns demonstrated the lowest mean gap values overall, followed by those pressed from pellets and those pressed from granules (P<.001). The interaction between the effects of the fabrication technique and the measurement point on the internal fit was statistically significant (P<.001). Except for the distal occlusal gap and mesial occlusal gap, all tested groups showed a statistically significant difference (P<.001). In addition, statistically significant differences were observed among all measurement points in different fabrication techniques (P<.001).

CONCLUSIONS

The marginal and internal fit of milled PEEK crowns was significantly better than pressed crowns. However, both CAD-CAM and heat-pressing techniques produced PEEK crowns with a clinically acceptable marginal and internal fit. The mean marginal gap of the PEEK crowns pressed from granules was above the range of clinically acceptable value.

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.

Evaluating the accuracy of CAD/CAM optimized stones compared to conventional type IV stones

This study compared the accuracy (trueness and precision) of stone models fabricated using two brands of CAD/CAM optimized stones Cerec Stone (BC) and Elite Master (EM), and a conventional type IV stone Elite Rock Fast (ERF). 30 conventional Type IV and scannable stone complete-arch models were scanned with a blue LED extraoral scanner, and root mean square values were obtained. 6 abutments were used in complete-arch models. The digital models were compared with the master model to evaluate their trueness using model superimposition with Geomagic software. Precision was determined for each case by superimposing combinations of the 10 datasets in each group. The point cloud density of each model was calculated with MeshLab software. Kruskal-Wallis and Mann-Whitney non-parametric tests were used for the statistical analysis. The trueness of the stone models was 96 μm for the BC, 88.2 μm for the EM, and 87.6 μm for the ERF. There were no significant differences between the tested dental stones (p = .768). However, the EM models (35.6 μm) were more precise than the BC (46.9 μm) and ERF (56.4 μm) models (p = .001, p < .001). EM models also showed the highest point cloud density. There were significant differences in point cloud density (p = .003). The EM models showed significant differences in precision but no significant differences in terms of trueness. Although EM was more precise and had the highest point cloud density, all models were within the clinically acceptable limit.

Evaluation of intaglio surface trueness, wear, and fracture resistance of zirconia crown under simulated mastication: a comparative analysis between subtractive and additive manufacturing

PURPOSE

This in-vitro analysis aimed to compare the intaglio trueness, the antagonist's wear volume loss, and fracture load of various single-unit zirconia prostheses fabricated by different manufacturing techniques.

MATERIALS AND METHODS

Zirconia crowns were prepared into four different groups (n = 14 per group) according to the manufacturing techniques and generations of the materials. The intaglio surface trueness (root-mean-square estimates, RMS) of the crown was measured at the marginal, axial, occlusal, and inner surface areas. Half of the specimens were artificially aged in the chewing simulator with 120,000 cycles, and the antagonist's volume loss after aging was calculated. The fracture load for each crown group was measured before and after hydrothermal aging. The intaglio trueness was evaluated with Welch's ANOVA and the antagonist's volume loss was assessed by the Kruskal-Wallis tests. The effects of manufacturing and aging on the fracture resistance of the tested zirconia crowns were determined by two-way ANOVA.

RESULTS

The trueness analysis of the crown intaglio surfaces showed surface deviation (RMS) within 50 µm, regardless of the manufacturing methods (P = .053). After simulated mastication, no significant differences in the volume loss of the antagonists were observed among the zirconia groups (P = .946). The manufacturing methods and simulated chewing had statistically significant effects on the fracture resistance (P < .001).

CONCLUSION

The intaglio surface trueness, fracture resistance, and antagonist's wear volume of the additively manufactured 3Y-TZP crown were clinically acceptable, as compared with those of the 4Y- or 5Y-PSZ crowns produced by subtractive milling.

Fit of zirconia fixed partial dentures fabricated from conventional impressions and digital scans: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Available studies comparing fit accuracy of zirconia fixed partial dentures (FPDs) fabricated from conventional impressions and digital scans provide contradictory results. In addition, studies have been heterogeneous and of a limited number to provide conclusive evidence.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the marginal and intaglio fit of tooth-supported zirconia FPDs fabricated from conventional impressions and digital scans and to investigate the effect of different variables on the fit results.

MATERIAL AND METHODS

An electronic search was performed on the National Library of Medicine (NLM), Cochrane Central Register of Controlled Trials, and Scopus databases. In addition, a manual search was carried out. Studies comparing the fit of tooth-supported zirconia FPDs fabricated from conventional impressions and digital scans and reporting sufficient data for qualitative and quantitative analysis were included. Standard mean differences (SMDs) and 95% confidence intervals (CI) were calculated for meta-analysis. Subgroup analysis was performed to study the effect of variables including restoration form (monolithic or framework), units number, intraoral scanner (IOS) type, conventional impression material, spacer thickness, and abutments region.

RESULTS

The initial search resulted in a total of 608 articles. Nine articles were included in the analysis (1 clinical and 8 in vitro) evaluating 118 restorations. Digital scan displayed significantly better marginal fit (P<.001; SMD: -0.68; 95% CI: -0.92, -0.09) and intaglio fit (P=.020; SMD: -0.51; 95% CI: -0.94, -0.42). Test for subgroup difference showed a significant influence of only impression material type (P=.008) and units number (P=.030) on marginal fit. Digital scan showed significantly better marginal accuracy for 3-unit FPDs than 4-unit FPDs (P<.001; SMD: -1.02; 95% CI: -1.41, -0.63). In addition, digital scanning had significantly better marginal fit with polyvinyl siloxane than polyether (P<.001; SMD: -0.98; 95% CI: -1.32, -0.64). A cement spacer ≤50 μm improved both marginal and intaglio fit in the digital group. The TRIOS scanner resulted in the best performance in the digital group for marginal fit.

CONCLUSIONS

Digital scanning provides significantly better marginal and intaglio fit than conventional impression making for fabricating zirconia FPDs up to 4 units, either in monolithic form or frameworks and at any region of the arch. However, further clinical studies are recommended to obtain more substantial results.

Marginal fit of 3-unit CAD-CAM zirconia frameworks fabricated using cone beam computed tomography scans: an experimental study

Whether cone beam computed tomography (CBCT) scans can be used for the fabrication of computer-aided design and computer-aided manufacturing (CAD-CAM) fixed dental prostheses (FDPs) is not known. The purpose of the present study was to compare the marginal fit of 3-unit zirconia FDPs fabricated by using CBCT or 3-dimensional (3D) laboratory scanning. Extracted second premolar and molar teeth in a maxillary typodont model were prepared. The first molar was removed and the typodont model was scanned with a laboratory or a CBCT scanner to generate two virtual 3D cast groups (3DL and CBCT). Forty four 3-unit zirconia FDPs were designed on virtual casts and milled. The vertical marginal discrepancy (VMD) was measured by ×100-magnification microscopy at seven locations on each abutment. A total of 616 measurements were made at 14 fixed locations in two groups of 22 specimens. The VMD data for 3DL and CBCT groups were statistically analyzed using the Mann-Whitney U test (α = 0.05). The mean VMDs on premolar ranged between 44 and 55 µm (median: 43-55 µm) in 3DL, and 74 and 100 µm (median: 72-93 µm) in CBCT; and on the molar, between 47 and 114 µm (median: 46-114 µm) in 3DL, and 91 and 162 µm (median: 93-156 µm) in CBCT. There was a significant difference between the gaps in 3DL and CBCT groups (p < 0.001). FDPs fabricated using 3D laboratory scanner had significantly smaller VMDs. Nevertheless, the 3-unit zirconia FDPs fabricated using CBCT scans presented promising marginal integrity.

Evaluation of the marginal fit of monolithic crowns fabricated by direct and indirect digitization

Purpose To evaluate the influence of intraoral and extraoral digitization systems on marginal discrepancy of monolithic lithium disilicate and monolithic zirconia computer-aided design-computer-aided manufacturing (CAD-CAM) crowns.Methods Forty standardized machined stainless steel specimens with the characteristics of a first molar were manufactured and randomly assigned to two groups (n=20 each), depending on their material: monolithic lithium disilicate ceramic (LM), and monolithic zirconia (ZM). Then, each group was subdivided into two depending on the scanning system used: intraoral scanner (IOS), and extraoral scanner (EOS). The digitization process was standardized with two methacrylate devices, one for each scanner. After scanning and manufacturing of the crowns, the marginal discrepancy was measured under a scanning electron microscope (SEM). Data analysis was made using two-way analysis of variance (ANOVA) and the effect size with Cohen's d.Results All the measurements were within the limits considered acceptable. Regardless the restorative material significant differences between scanners were observed, being the effect from low to moderate. However, no differences were observed between the scanners in either the lithium disilicate or zirconia group.Conclusions The intraoral scan showed lower marginal discrepancy than the extraoral scan in CAD-CAM monolithic crowns, but these differences were not observed in each of the ceramic systems.

Comparison of marginal and internal fit of three-unit implant-supported fixed prosthetic substructures fabricated using CAD/CAM systems

OBJECTIVE

This study compared the marginal and internal fit of implant-supported fixed dentures fabricated using CAD/CAM systems.

MATERIALS AND METHODS

A lower jaw model representing partial edentulism was produced. Two dental implants were inserted in the area of teeth 35 and 37, onto which cemented abutments were screwed. The model was scanned using a laboratory scanner and transferred to a design software program for substructure fabrication. Sixty substructures were fabricated out of each group for six substructure types (n = 10), cast Co-Cr (control), milling Co-Cr, laser sintering Co-Cr, titanium (Ti), zirconium, and polyetheretherketone (PEEK) substructures. The marginal and internal fit was evaluated using a silicone replica viewed under a stereomicroscope. The data were analyzed using the statistical package program for social sciences (SPSS, Chicago, IL, USA, v. 17) at a significance level of 0.05. Marginal and internal gaps were compared using the one-way ANOVA test and Tukey's post hoc test. The differences between abutment teeth were determined using the independent sample t-test.

RESULTS

There was a significant difference in the marginal gap between PEEK and Ti groups (p < 0.05) but no difference between other groups (p > 0.05). There was a significant difference in the internal gap between PEEK, laser sintering Co-Cr, and milling Co-Cr groups (p < 0.05) but no difference between other groups (p > 0.05). The PEEK group had a higher marginal gap than the Ti group and a higher internal gap than the DMLS Co-Cr group (p < 0.05).

CONCLUSION

All substructures have a marginal and internal fit within acceptable clinical limits.

CLINICAL RELEVANCE

This in vitro study suggests that materials and techniques used in CAD/CAM systems improve the fitting accuracy of implant-supported fixed restorations.

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.

Influence of milling systems and marginal configurations on the fit of yttrium stabilized tetragonal zirconia polycrystals (Y-TZP)' copings

OBJECTIVE

The aim of this study was to evaluate marginal fit of yttrium tetragonal zirconia polycrystals (Y-TZP)' copings with different finish line designs fabricated with various digital scanners and milling systems.

METHODS

Three model plastic teeth were prepared with three finish line designs: Design-1, continuous chamfer; Design-2, chamfer with shallow depression; Design-3, chamfer with deep depression. The "master models" were replicated using elastomeric polyvinyl siloxane impression material and poured in type IV stone generating 90 dies, 30 dies for each design. Dies were scanned and copings were milled utilizing three digital scanners and computer-aided design/computer-aided manufacturing (CAD/CAM) systems: System-1, InEos Red Scan (Sirona Dental Systems, Germany), Vitablocks® Mark II (VITA, Germany) copings milled by Cerec® inLab (Sirona Dental Systems, Germany); System-2, Cerec® AC Connect with BlueCam (Sirona Dental Systems, Germany), Vitablocks® Mark II (VITA, Germany) copings milled by Cerec® inLab (Sirona Dental Systems, Germany); and System-3, NobleProcera™ Optical Scanner (NobleBiocare™), procera zirconia coping milled by a Noble Procera™ milling machine (NobleBiocare™). Copings were seated on their respective "master models" and secured with uniform force. Eight measurements per coping were performed at pre-established points, with a metallurgical microscope (Zeiss, Germany) connected to a high precision digital video-micrometer (Javelin JV6000, California, USA) at 200 × magnification.

RESULTS

The tested systems demonstrated marginal gaps ranging from 12.4 to 26.6 µm. Results for marginal fit of milled copings fabricated using three systems with different finish line designs differed significantly (p < 0.05). Procera zirconia copings scanned and milled with NobleProcera™ exhibited significantly lower marginal gaps compared to other specimen groups. However, InEos Red Scan/Vitablocks® Mark II/Cerec® inLab showed maximum marginal gaps among the study specimens.

CONCLUSIONS

CAD-CAM manufactured Y-TZP' copings exhibited marginal gaps ranging from 12.49 to 26.6 µm. The CAD-CAM fabrication system was a significant factor influencing the marginal misfit of Y-TZP' copings. Margin design exhibited system dependent influence on the marginal misfit. Marginal misfit observed for all systems were within clinically acceptable parameters.

Influence of contemporary CAD-CAM milling systems on the fit and adaptation of partially stabilized Zirconia fixed partial dentures

Objective:

To evaluate marginal fit and internal adaptation of three-unit Zr frameworks fabricated from four Zr CAD/CAM milling systems.

Methods:

Fixed partial denture models were replicated (40 stone models) using Polyvinyl Siloxane impression material (PVS) and type IV stone for Zr framework fabrication. FPDs were milled with four CAD/CAM systems, Group-II: LAVAL Zirconia milled by LAVA , Group-2: Vita In-Ceram YZ milled by Cerec®, Group-3: Zirconia milled by GM1000 and Group-4: Zirconia milled by DWX-50N. Twelve marginal gap measurements per framework were performed at pre-established points, with a metallurgical microscope (Zeiss, Germany) at 500X magnification. Eight measurements of cement space per section were performed for adaptation. Data was analyzed using ANOVA and Tukey post hoc test.

Results:

Zirconia FPD frameworks exhibited gaps ranging from 16 to 50.1 µm for marginal fit and 26.8 to 102.5 µm for internal adaptation. Group-3 [20.8 (8.3) µm & 50.3 (11.4) µm] and Group-4 [16.0 (4.0) µm & 40.2 (8.8) µm] specimens showed significantly lower marginal fit and internal adaptation gaps compared to Group-I [50.1 (13.4) µm & 100.5 (16.7) µm] and Group-2 [38.9 (8.2) µm & 102.5 (13.4) µm] specimens respectively.

Conclusions:

Different CAD-CAM systems for fabrication of Zr FPD frameworks displayed a significant influence on marginal fit and internal adaptation of restorations.

Effect of cementation and aging on the marginal fit of veneered and monolithic zirconia and metal-ceramic CAD-CAM crowns

STATEMENT OF PROBLEM

Marginal fit of zirconia restorations is an important criterion for their long-term success. However, in spite of the wide use of zirconia in dentistry, the relationship between marginal fit and low-temperature degradation from aging is unclear.

PURPOSE

The purpose of this in vitro study was to compare the marginal adaptation of veneered and monolithic zirconia and metal-ceramic computer-aided design and computer-aided manufacturing (CAD-CAM) crowns before and after cementation and to evaluate the influence of artificial aging on the adaptation of zirconia crowns.

MATERIAL AND METHODS

Seventy-two standardized dies were prepared to receive a posterior crown and randomly divided into 6 groups (n=12) as per the material and the presence or not of cement: metal-ceramic, veneered zirconia, and monolithic zirconia. The zirconia groups were subjected to accelerated low-temperature degradation through hydrothermal aging in an autoclave at 131 °C and 0.17 MPa for 5 and 20 hours. A scanning electron microscope with a magnification of ×1000 was used for marginal adaptation measurements, and X-ray diffraction (XRD) was used to characterize phase transformation degradation. The data were statistically analyzed using 2-way ANOVA, repeated measures ANOVA with Greenhouse-Geisser correction, and the t test (α=.05).

RESULTS

No significant differences in the marginal discrepancy were recorded among the analyzed groups. The presence of cement did not influence marginal fit in any treatment group. No significant differences were observed in the marginal adaptation values before and after aging (P>.05). After 20 hours of aging, the monoclinic phase increase to 8.3% on veneered zirconia and to 3.1% on monolithic crowns.

CONCLUSIONS

Monolithic and bilayer CAD-CAM zirconia crowns showed marginal gaps that were within an acceptable range of clinical discrepancy, regardless of cementation. Marginal adaptation was not influenced by aging. Low-temperature degradation did not lead to a significant transformation from the tetragonal to monoclinic phase.

Accuracy evaluation of complete-arch models manufactured by three different 3D printing technologies: a three-dimensional analysis

Purpose This study aimed to evaluate the trueness and precision of complete-arch models printed with three-dimensional printers via three different printing technologies.Methods An arch-shaped master model was designed using software (RapidForm XOR2, 3D Systems Inc., USA), and the digital master model was printed 10 times with three-dimensional printers using stereolithography (SLA), direct light processing (DLP), and Polyjet technology (n = 30). The printed models were then scanned with an industrial scanner to create the respective digital models. All digital models were compared with the master model, and an evaluation of the trueness was performed by model superimposition with Geomagic Control software (3D Systems, Rock Hill, SC, USA). Precision was determined for each case by superimposing some combination of the 10 datasets in each group.Results The trueness of the printed models was 46.2 µm for the DLP printer, 51.6 µm for the SLA printer, and 58.6 µm for the Polyjet printer. The DLP models were significantly better than the Polyjet models (p = .005). However, the Polyjet models (30.4 µm) were more precise than the SLA (37.6 µm) and DLP (43.6 µm) models (p < .001, p = .016). Furthermore, the SLA (11.8 µm) was the most accurate printer in the Z-direction (p = .016, p = .002).Conclusions The 3D printing technologies showed significant differences in the precision and trueness of complete-arch measurements. Although DLP was more accurate other tested 3D printers, the accuracy of all 3D printed models was within clinical tolerance, and they were clinically acceptable and could be used for the production of fixed restorations.

Disposable plastic trays and their effect on polyether and vinyl polysiloxane impression accuracy-an in vitro study

OBJECTIVES

To evaluate the dimensional accuracy of impressions taken by use of disposable stock plastic trays and to compare performance with that of metal trays.

MATERIALS AND METHODS

From a metallic model incorporating three precision balls and three abutment teeth, one-step dual-phase polyether (PE) and vinyl polysiloxane (VPS) impressions were taken using either metal or disposable plastic trays (n = 10 for each of the resulting four test groups). Respective plaster cast scans were aligned with the reference dataset to evaluate global (distance and angle deviations) and local (trueness and precision) accuracy. Analyses of variance (ANOVA) were conducted to determine group differences.

RESULTS

For all impression tray and material combinations, global accuracy was good (mean distance changes < 100 μm) with greatest deviations being observed for distances exceeding one quadrant of the dental arch. In general, distances measured in the plaster casts were too short. Only VPS impressions with plastic trays showed a different behavior with a large percentage of cross-arch distances exceeding the reference value. Mean local accuracy ranged between 6 and 14 μm (trueness), and 6 and 16 μm (precision). On abutment tooth level, metal trays were associated with a significantly better precision (p = 0.015).

CONCLUSIONS

The observed distortions of the studied impression trays and materials are small and should enable satisfying clinical impression-taking.

CLINICAL RELEVANCE

Cleaning and processing of metal trays before re-use are time-consuming. Especially for patients' management with single crowns and small fixed dental prostheses, disposable plastic trays can be a viable and cost-effective alternative.

Effect of different fabrication techniques on the marginal precision of polyetheretherketone single-crown copings

STATEMENT OF PROBLEM

Demand is increasing for polyetheretherketone (PEEK) as a fixed dental prosthesis core material. However, information is lacking about how the precision of these restorations is affected by the fabrication procedures.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of different fabrication techniques on the marginal precision of PEEK single-crown copings.

MATERIAL AND METHODS

A stainless-steel master die was designed to simulate a prepared mandibular second molar to receive ceramic crowns. Thirty PEEK copings were fabricated and divided into 3 groups (n=10) according to the fabrication technique: milled from a prefabricated PEEK blank by using a computer-aided design and computer-aided manufacturing (CAD-CAM) system (PC); pressed from prefabricated PEEK pellets (PP); and pressed from PEEK granules (PG); in addition, 3-mol yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) copings (n=10) were produced by using the same CAD-CAM system and served as a control. Marginal precision measurements (in μm) were recorded at 4 reference points on each coping by using a digital microscope. The data obtained were statistically analyzed by using 1-way ANOVA and the pair-wise Tukey (HSD) test to study the difference between group mean values (α=.05).

RESULTS

The overall mean ±standard deviation marginal gap at the marginal opening for the copings was 78 ±10 μm for PEEK granules copings, 72 ±9 μm for PEEK pellet copings, 45 ±6 μm for PEEK CAD-CAM copings, and 43 ±1 μm for the 3Y-TZP CAD-CAM control. A statistically significant difference was found between the milled and pressed copings as indicated by the ANOVA test (P<.001). The pair-wise Tukey honestly significant difference (HSD) test showed a nonsignificant difference (P>.05) between milled 3Y-TZP and milled PEEK copings; moreover, no significant difference was observed between the PEEK copings pressed from pellets or granules (P>.05).

CONCLUSIONS

The marginal precision of PEEK CAD-CAM-fabricated copings showed significantly lower mean marginal gap values than PEEK pressed copings. The marginal gap mean values recorded were all within a clinically acceptable range (120 μm).

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.

Influence of the Fabrication Technique on the Marginal and Internal Adaptation of Ceramic Onlays

This study aimed to evaluate the marginal and internal adaptation of partial coverage crowns (ceramic onlays) fabricated with Press, CEREC BlueCam, and CEREC OmniCam systems, using two preparation designs and evaluating the internal discrepancies at different locations. Two phantom maxillary premolars (master teeth) received different preparation designs, with (BX) and without (NB) a modified occlusal box with round internal angles. Sixty IPS e-max ceramic restorations were fabricated with three systems: Press (n=20), CEREC BlueCam (n=20), and CEREC OmniCam (n=20). Both marginal and internal discrepancy width were measured by using a stereomicroscope at ×25 magnification. The data were evaluated statistically using analysis of variance followed by Tukey's Honestly Significant Difference test (α=0.05). The ceramic restorations fabricated with the Press system presented significantly smaller marginal and internal disadaptations than the BlueCam and OmniCam CEREC systems (p&lt;0.0001). Regarding the preparation designs, preparation BX presented the smallest marginal discrepancies for all fabrication systems and larger internal discrepancies than for restorations fabricated with the Press system. The occlusal location presented a larger internal discrepancy compared with the axial locations. Although the three systems resulted in the fabrication of restorations within a clinically acceptable adaptation with marginal discrepancies below 100 μm, the Press system presented the smallest marginal and internal discrepancies. An improved marginal adaptation was observed in the preparation design with a modified occlusal box with rounded internal angles.

Accuracy of digitization obtained from scannable and nonscannable elastomeric impression materials

STATEMENT OF PROBLEM

Elastomeric impression materials have been marketed for optimizing direct digital acquisition without requiring a stone cast. The trueness and precision of the digitization of these new elastomeric impression materials are unclear.

PURPOSE

The purpose of this in vitro study was to compare the trueness and precision of digital dental casts obtained from the direct digitization of 2 types of vinylsiloxanether (VSXE) impression materials by using a laboratory laser scanner.

MATERIAL AND METHODS

Thirty-eight elastomeric impressions were made of a master die with a similar morphology to a premolar crown preparation. The impression materials were Identium (IDE) and Identium Scan (SCAN), designed for direct digitalization. Each impression was digitalized by using an optical scanner to create digital casts. A computer-aided design (CAD) reference model of trueness (CRM) was created and aligned to each digital cast for digital 3-dimensional discrepancy analysis.

RESULTS

The mean ±standard deviation global trueness of IDE was 53 ±16 μm and that of SCAN was 46 ±3 μm. SCAN digital casts showed higher precision (58 ±5 μm) than IDE (69 ±18 μm) (P<.05). At the margin of the preparation and at the axial surfaces, SCAN models showed higher trueness (3 ±6 μm and 1 ±5 μm) than IDE (15 ±10 μm and 2 ±37 μm), respectively.

CONCLUSIONS

Scannable impressions could be digitalized with higher global precision than conventional elastomeric materials. Higher trueness could be achieved in specific impression locations such as gingival areas or axial walls of preparations, where the light emitted by the scanner was not blocked.

Accuracy of CAD/CAM Digital Impressions with Different Intraoral Scanner Parameters

The advancement of intraoral scanners has allowed for more efficient workflow in the dental clinical setting. However, limited data exist regarding the accuracy of the digital impressions produced with various scanner settings and scanning approaches. The purpose of this in vitro study was to compare the accuracy of digital impressions at the crown preparation margin using different scanning resolutions of a specific intraoral scanner system. An all-ceramic crown preparation of a mandibular first molar was constructed in a typodont, and a scan (n = 3) was created with an industrial-grade laboratory scanner (3Shape D2000) as the control. Digital impressions were obtained with an intraoral scanner (3Shape TRIOS 3) under three settings—high resolution (HR), standard resolution (SR), and combined resolution (SHR). Comparative 3D analysis of scans was performed with Geomagic Control X software to measure the discrepancy between intraoral scans and the control scan along the preparation finish line. The scan time and number of images captured per scan were recorded. Statistical analysis was performed by one-way ANOVA, two-way repeated measures ANOVA, Pearson’s correlation, and Dunnett’s T3 test (α = 0.05). Significant differences were observed for scan time and for number of images captured among scan resolution settings (α < 0.05). The scan time for the SR group was, on average, 34.2 s less than the SHR group and 46.5 s less than the HR group. For discrepancy on the finish line, no significant differences were observed among scanning resolutions (HR: 31.5 ± 5.5 μm, SHR: 33.2 ± 3.7 μm, SR: 33.6 ± 3.1 μm). Significant differences in discrepancy were observed among tooth surfaces, with the distal surface showing the highest discrepancies. In conclusion, the resolution of the intra-oral scanner is primarily defined by the system hardware and optimized for default scans. A software high-resolution mode that obtains more data over a longer time may not necessarily benefit the scan accuracy, while the tooth preparation and surface parameters do affect the accuracy.

A comparison of the marginal gaps of lithium disilicate crowns fabricated by two different intraoral scanners

BACKGROUND

The purpose of this study was to assess marginal gaps of CAD/CAM lithium disilicate crowns constructed using two different intraoral scanners of different generations.

METHODS

Twenty four Columbia model lower left molars were prepared for lithium disilicate crowns in a simulated environment by undergraduate students. The crown preparations were scanned by E4D and Trios 3 intraoral scanners and CAD/CAM lithium disilicate crowns designed and manufactured. The crowns were seated onto the original crown preparations and three vertical marginal gap measurements taken at four locations (mid-buccal, mid-lingual, mid-mesial and mid-distal) using a stereomicroscope. The mean marginal gap (MMG) was calculated for each crown and each individual tooth surface.

RESULTS

The MMG was not statistically significantly different for the Trios 3 and E4D scanners (P = 0.111). There was no statistically significant effect of measurement location on the tooth on the marginal gap (P = 0.1134).

CONCLUSIONS

There was no difference in the MMGs of CAD/CAM lithium disilicate crowns constructed using two different intraoral scanners of different generations. Within the limitations of this study, the advances in scanning technology have produced small and insignificant improvements in the accuracy of crown margins.

Dimensional Changes of 3-Unit Implant-Supported Zirconia Frameworks of Two CAD/CAM Systems from Scanning to Sintering

Objectives:

Internal fit of implant frameworks is an important factor determining the long-term success of dental implant restorations. This in-vitro study aimed to evaluate dimensional changes of implant-supported zirconia frameworks fabricated by two computer-aided design/computer-aided manufacturing (CAD/CAM) systems from scanning to sintering.

Materials and Methods:

A master model of a three-unit fixed partial denture was fabricated with two implant abutments. In each CAD/CAM system (AmannGirrbach and Zirkonzahn), the master model was scanned 12 times, and data were saved as Standard Transformation Language files (scanning groups). Using semi-sintered zirconia, 12 real-size frameworks (milling groups) and 12 enlarged frameworks, were sintered (sintering groups) and made by each system. Dimensions of the master model and frameworks in each phase were measured. Dimensional changes (compared to the master model) were calculated. Data were analyzed using repeated measures analysis of variance, independent t-test, and paired sample t-test (α=0.05).

Results:

Comparison of the two systems revealed that although dimensional changes were greater in the milling phase of Zirkonzahn, they were larger in the sintering phase of the AmannGirrbach system. Evaluation of fabrication phases revealed greater dimensional changes in the milling phase compared to the other phases in the Zirkonzahn system (P<0.05). However, in the AmannGirrbach system, the values were not significantly different between milling and sintering phases (P>0.05).

Conclusion:

Within the limitations of this study, the results showed that fabrication phases, CAD/CAM system type and abutment size had significant effects on dimensional changes.

Variables affecting the fit of zirconia fixed partial dentures: A systematic review

STATEMENT OF PROBLEM

Different parameters affect the marginal and internal fit of zirconia fixed partial dentures (FPDs) on natural teeth. Determining a way to optimize these restorations is essential.

PURPOSE

The purpose of this systematic review was to determine the variables affecting the marginal fit and internal accuracy of zirconia FPDs on natural teeth.

MATERIAL AND METHODS

An electronic search was conducted by 2 independent reviewers by using the MEDLINE, Cochrane, Web of Science, and Scopus databases, as well as Google Scholar, for studies published up to July 2018, and a manual search was conducted from the reference lists of related articles. Eligibility criteria included articles in English published in peer-reviewed journals that assessed the marginal and/or internal adaptation of zirconia FPDs on teeth with 3 or more units, with at least 1 of the experimental groups being frameworks or FPDs fabricated from zirconia. Risk of bias was assessed with the aid of the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

The search provided 418 records, with 41 fulfilling the inclusion criteria. The selected studies showed considerable heterogeneity regarding materials, state of sintering, manufacturer and computer-aided design and computer-aided manufacturing (CAD-CAM) system, experimental methodology, sample size, and span length. Of the included articles, 36 were in vitro studies and 5 were clinical studies, most of which exhibited high-performance and detection biases. CAD-CAM systems provided more precise marginal and internal fit than CAM systems. An increase of framework span length to 6 or more units decreased both marginal and internal fit. The reported marginal gap tended to increase after the veneering process. The introduction of a conventional impression into an otherwise digital workflow seems to have a negative effect on the marginal fit.

CONCLUSIONS

The accuracy of zirconia FPDs or frameworks is considerably influenced by the processing procedure used and the choice of CAD-CAM system.

Effect of finish line design and metal alloy on the marginal and internal gaps of selective laser melting printed copings

STATEMENT OF PROBLEM

Selective laser melting (SLM) technology has been introduced for printing metal dental restorations from Co-Cr base alloys or Au-Pt high noble alloys. However, information regarding the fit of restorations fabricated by using this technique is limited.

PURPOSE

The purpose of this in vitro study was to determine the effect of 3 different finish line designs on the marginal and internal gaps of metal copings made from a base (Co-Cr), high noble (Au-Pd-Ag), and noble alloy (Co-Pd) by using the SLM technology.

MATERIAL AND METHODS

Three Ivorine right maxillary central incisors were prepared with a chamfer, deep chamfer, or shoulder finish line. The preparations were scanned by using a TRIOS scanner, and a total of 90 dies were printed using DPR 10 Resin (30×3 finish line designs). Ten SLM copings were fabricated for each margin design and metal alloy combination for a total of 90 copings (10×3 finish line designs×3 alloys). Copings were cemented onto dies using an autopolymerizing composite-resin luting material. All coping-die assemblies were sectioned buccolingually by using a low-speed diamond saw, and images were obtained by using an inverted bright field metallurgical microscope at ×100 magnification. Marginal and internal gaps were measured at 5 locations: buccal margin, midfacial, incisal, midlingual, and lingual margin. After gap measurements, representative specimens were embedded in autopolymerizing resin and prepared for metallographic examination. A 2-way multivariate analysis of variance (MANOVA) was conducted to determine the overall significance, followed by ANOVA for each dependent variable (α=.05).

RESULTS

The results indicated that alloy type and finish line had a significant influence on marginal gap of copings (P<.001). Relative to the internal gap, alloy type had a significant effect (P<.001), but the type of finish line had no statistically significant influence (P=.337). No statistically significant interactions occurred. Base alloys were printed with almost no observable porosity, whereas noble and high noble alloys exhibited hot tears and porosity.

CONCLUSIONS

Thefinish line type did not influence the internal gap between copings and dies, whereas the alloy type influenced the marginal gap between copings and dies. SLM-fabricated Co-Cr copings on teeth prepared with a deep chamfer finish line demonstrated the lowest marginal gap.

Micro-CT Analysis of Y-TZP Copings Made by Different CAD/CAM Systems: Marginal and Internal Fit

Purpose

The aim of the study was to measure the marginal and internal adaptation (MIA) of zirconia copings, made of 4 ceramic systems for CAD/CAM, using microcomputed tomography (micro-CT) technology.

Material and Methods

Two identical stainless steel models were used, representing a preparation for full ceramic crown on a lower molar. The master models were then scanned for the production of copings from specific yttrium oxide partially stabilized tetragonal zirconia polycrystal ceramic blocks of each system (n=10): Cerec/inCoris Zi, Sirona; Cercon/Cercon base, Dentsply; Ceramill/Ceramill Zi, Amann Girrbach; and Lava/Lava Frame Zirconia, 3M ESPE. MIA was evaluated measuring 4 points as follows: marginal gap (MG), axial wall gap (AW), axio-occlusal angle gap (AO), and central occlusal area gap (CO). The data were statistically analyzed by ANOVA and Tukey's test (α = 0.05).

Results

The ceramic system Lava showed greater internal desadaptation (80.75 ± 22.69 µm) while CEREC presented the lowest values (49.92 ± 11.77 µm). There were significant differences between the measurement points evaluated. CO demonstrated the greater values (77.03 ± 22.61 µm). All marginal and internal adaptation values were considered clinically acceptable.

Conclusion

It was concluded that there was an influence of the type of ceramic system in marginal and internal adaptation of copings in zirconia.

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.

[Comparative evaluation of the marginal accuracy of single crowns fabricated computer using aided design/computer aided manufacturing methods, self-curing resin and Luxatemp]

OBJECTIVE

This study aims to compare the marginal accuracy of single crowns fabricated using self-curing resin, Luxatemp, and computer aided design/computer aided manufacturing (CAD/CAM) methods in clinical application.

METHODS

A total of 30 working dies, which were obtained from 30 clinical teeth prepared with full crown as standard, were created and made into 30 self-curing resin, Luxatemp, and CAD/CAM single crowns. The restorations were seated on the working dies, and stereomicroscope was used to observe and measure the thickness of reference points. One-way analysis of variance, which was performed using SPSS 19.0 software package, compared the marginal gap widths of self-curing resin, Luxatemp, and CAD/CAM provisional crowns.

RESULTS

The mean marginal gap widths of the fabricated self-curing resin, Luxatemp, and CAD/CAM were (179.06±33.24), (88.83±9.56), and (43.61±7.27) μm, respectively. A significant difference was observed among the three provisional crowns (P<0.05).

CONCLUSIONS

The marginal gap width of CAD/CAM provisional crown was lower than that of the self-curing resin and Luxatemp. Thus, the CAD/CAM provisional crown offers a better remediation effect in clinical application.

Effect of dental technician disparities on the 3-dimensional accuracy of definitive casts

STATEMENT OF PROBLEM

Studies that evaluated the effect of dental technician disparities on the accuracy of presectioned and postsectioned definitive casts are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the accuracy of presectioned and postsectioned definitive casts fabricated by different dental technicians by using a 3-dimensional computer-aided measurement method.

MATERIAL AND METHODS

An arch-shaped metal master model consisting of 5 abutments resembling prepared mandibular incisors, canines, and first molars and with a 6-degree total angle of convergence was designed and fabricated by computer-aided design and computer-aided manufacturing (CAD-CAM) technology. Complete arch impressions were made (N=110) from the master model, using polyvinyl siloxane (PVS) and delivered to 11 dental technicians. Each technician fabricated 10 definitive casts with dental stone, and the obtained casts were numbered. All casts were sectioned, and removable dies were obtained. The master model and the presectioned and postsectioned definitive casts were digitized with an extraoral scanner, and the virtual master model and virtual presectioned and postsectioned definitive casts were obtained. All definitive casts were compared with the master model by using computer-aided measurements, and the 3-dimensional accuracy of the definitive casts was determined with best fit alignment and represented in color-coded maps. Differences were analyzed using univariate analyses of variance, and the Tukey honest significant differences post hoc tests were used for multiple comparisons (α=.05).

RESULTS

The accuracy of presectioned and postsectioned definitive casts was significantly affected by dental technician disparities (P<.001). The largest dimensional changes were detected in the anterior abutments of both of the definitive casts. The changes mostly occurred in the mesiodistal dimension (P<.001).

CONCLUSIONS

Within the limitations of this in vitro study, the accuracy of presectioned and postsectioned definitive casts is susceptible to dental technician differences.

Comparative evaluation of bonding strength of computer aided machined ceramic, pressable ceramic, and milled metal implant abutment copings and effect of surface conditioning on bonding strength: An in vitro study

Background/Purpose:

The aim of this study was to compare the shear bond strength of computer aided design/computer aided machined ceramic (CAD/CAM), pressable ceramic, and milled metal implant copings on abutment and the effect of surface conditioning on bonding strength.

Materials and Methods:

A total of 90 test samples were fabricated on three titanium abutments. Among 90 test samples, 30 copings were fabricated by CAD/CAM, 30 by pressable, and 30 by milling of titanium metal. These 30 test samples in each group were further subdivided equally for surface treatment. Fifteen out of 30 test samples in each group were surface conditioned with airborne particle abrasion. All the 90 test samples were luted on abutment with glass ionomer cement. Bonding strength was evaluated for all the samples using universal testing machine at a crosshead speed of 5 mm/min. The results obtained were compared and evaluated using one-way ANOVA with post-hoc and unpaired t-test at a significance level of 0.05.

Results:

The mean difference for CAD/CAM surface conditioned subgroup was 1.28 ± 0.12, for nonconditioned subgroup was 1.20 ± 0.11. The mean difference for pressable surface conditioned subgroup was 1.18 ± 0.04, and for nonconditioned subgroup was 0.75 ± 0.28. The mean difference for milled metal surface conditioned subgroup was 2.57 ± 0.58, and for nonconditioned subgroup was 1.49 ± 0.15.

Conclusions:

On comparison of bonding strength, milled metal copings had an edge over the other two materials, and surface conditioning increased the bond strength.

Influence of Tooth Preparation Design on Fitting Accuracy of CAD-CAM Based Restorations

OBJECTIVE

The purpose of this study was to evaluate the marginal fit of different zirconia and metal frameworks and compare them with each other on different finish line configurations.

MATERIALS AND METHODS

20 stainless steel dies 10 with shoulder and 10 with chamfer finish line including 6 mm preparation height and 3 degree axial angle simulating a 6 degree total occlusal covergence of the prepared tooth were produced. After embedding the each group of die into the arch-shaped acrylic resin blocks, impressions were made using silicone based impression material and 120 casts were prepared subsequently. The dies were divided into six groups each having 20 specimens (10 with shoulder, 10 with chamfer finish line). Group CM consisted of Co-Cr produced by conventional casting procedure, group MM of Co-Cr prepared by metal milling, group LM of Co-Cr prepared by direct laser metal sinterization (DLMS), group ZZ of Zirkonzahn (Zirkonzahn GmbH, Gais, Italy), group LZ of Lava Zirconia (3 M ESPE Dental AG, Seefeld, Germany) and group DZ of DC-Zirkon (DCS Dental AG, Allschwil, Switzerland). Stereomicroscope were used to evaluate the marginal fit of frameworks and marginal gap values obtained from the images were analyzed using Mann-Whitney U Test and Kruskal-Wallis H Test with Bonferroni correction.

RESULTS

The lowest value of marginal gap was identified in the samples from the LZ group and the highest value was identified in those from ZZ in both finish lines. The effect of finish lines was not significant for most groups but CM frameworks with chamfer finish lines and the DZ frameworks with shoulder finish lines showed significantly lower marginal gap values.

CONCLUSION

The marginal gaps of the various tested zirconia and metal framework were within the range of clinical acceptability (120 µm).

CLINICAL SIGNIFICANCE

The results of this in vitro study suggest that margin preparation design and type of zirconia and metal framework materials for various CAD-CAM systems have a significant effect on marginal fit of the resulting restorations. (J Esthet Restor Dent 28:238-246, 2016).

Evaluation of marginal fit and internal adaptation of zirconia copings fabricated by two CAD - CAM systems: An in vitro study

Statement of Problem:

Three main factors which determine the success of an All-ceramic restoration are esthetic value, resistance to fracture and third being the marginal fit. Marginal fit and internal adaptation are crucial factors in increasing the longevity of the restoration. Newer and economical CAD CAM systems have been introduced claiming better marginal fit and adaptation of All ceramic crowns. CAD CAM systems involves scanning of the die or the tooth preparation and milling of the restoration, which may have variations among the systems available.

Aim of the Study:

Our study intended to check the marginal fit and internal adaptation of commonly used CAD CAM systems namely CERAMILL and CEREC -In Lab MC XL.

Materials and Methods:

Two groups of typodont teeth (n = 10) were prepared using a standardized protocol to receive All ceramic copings. 10 samples of Group A were used for fabrication of copings using CERAMILL system and 10 samples of Group B were used for fabrication of copings using CEREC -In Lab MC XL system. They were then luted with glass ionomer cement under mild finger pressure. Samples were embedded in resin and sliced longitudinally. They were then viewed under stereomicroscope and readings were measured along 15 points using ImageScope software. The P value was set at 0.05 at 95% confidence interval with 80% power. The data were checked for normality and unpaired t-test was used to evaluate the results of the two groups.

Results:

The overall internal adaptation was 61.5 ± 5.2 μm for CERAMILL and 56.9 ± 5.7 μm for CEREC -In Lab MC XL (P < 0.05). The marginal fit for CERAMILL was 83 μm and for CEREC -In Lab MC XL was 68 μm (P < 0.05).

Conclusion:

The marginal adaptation of CEREC -In Lab MC XL (68 μm) was found to be superior to CERAMILL (83 μm) (P < 0.05). Both the CEREC -In Lab MC XL and CERAMILL copings demonstrated internal adaptation and marginal fit within acceptable discrepancy range. When corroborating both the internal adaptation and marginal fit, CEREC -In Lab MC XL was found to be better than CERAMILL.

Evaluation and comparison of the marginal adaptation of two different substructure materials

PURPOSE

In this study, we aimed to evaluate the amount of marginal gap with two different substructure materials using identical margin preparations.

MATERIALS AND METHODS

Twenty stainless steel models with a chamfer were prepared with a CNC device. Marginal gap measurements of the galvano copings on these stainless steel models and Co-Cr copings obtained by a laser-sintering method were made with a stereomicroscope device before and after the cementation process and surface properties were evaluated by scanning electron microscopy (SEM). A dependent t-test was used to compare the mean of the two groups for normally distributed data, and two-way variance analysis was used for more than two data sets. Pearson's correlation analysis was also performed to assess relationships between variables.

RESULTS

According to the results obtained, the marginal gap in the galvano copings before cementation was measured as, on average, 24.47 ± 5.82 µm before and 35.11 ± 6.52 µm after cementation; in the laser-sintered Co-Cr structure, it was, on average, 60.45 ± 8.87 µm before and 69.33 ± 9.03 µm after cementation. A highly significant difference (P<.001) was found in marginal gap measurements of galvano copings and a significant difference (P<.05) was found in marginal gap measurements of the laser-sintered Co-Cr copings. According to the SEM examination, surface properties of laser sintered Co-Cr copings showed rougher structure than galvano copings. The galvano copings showed a very smooth surface.

CONCLUSION

Marginal gaps values of both groups before and after cementation were within the clinically acceptable level. The smallest marginal gaps occurred with the use of galvano copings.

Effect of anatomic, semi-anatomic and non-anatomic occlusal surface tooth preparations on the adaptation of zirconia copings

PURPOSE

To compare the accuracy of marginal and internal adaptation of zirconia (Zr) copings fabricated on anatomic (A), semi-anatomic (SA) and non-anatomic (NA) occlusal surface preparations.

MATERIALS AND METHODS

45 extracted bicuspid teeth were prepared for receiving zirconia crowns, with different occlusal preparation designs A=15, SA=15 & NA=15. The Zr copings were fabricated by using CAD4DENT, CAD/CAM. The copings were adjusted, cemented and were cross sectioned centrally from buccal cusp tip to lingual cusp tip into mesial and distal halves. The copings were examined under electron microscope at ×200 magnification and the measurements were recorded at 9 predetermined areas in micrometers.

RESULTS

Overall mean gap values for the three groups was found to be 155.93±33.98 µm with Anatomical Occlusal preparation design having the least gap value of 139.23±30.85 µm showing the best adaptation among the groups. Post Hoc Tukey's test showed a statistically significant difference (P=.007) between the means of gap for A & NA preparation designs. Measurements recorded at 9 predetermined points showed variations for the three groups.

CONCLUSION

Anatomical occlusal preparation designs resulted in better marginal and internal adaptation of Zr copings. There is a considerable variation between the measured marginal and internal gap values for the Zr copings fabricated by the (CAD4DENT-CAD/CAM). This variation may be associated with the lack of standardization of the preparation of teeth, computerized designing of the coping for each tooth, cement used, uniform pressure application during the cementation of the copings, sectioning of the copings and the microscopic measurements.

Evaluation of the marginal fit of full ceramic crowns by the microcomputed tomography (micro-CT) technique

Objective:

To evaluate the marginal gap (MG) and absolute marginal discrepancy (MD) of full ceramic crowns with two finish line designs, shoulder and chamfer, using microcomputed tomography (micro-CT) before and after cementation.

Materials and Methods:

Sixty extracted human maxillary premolar teeth were divided into two groups based on the finish line design: Group I: 90° shoulder and Group II: 135° chamfer. The specimens were further grouped based on the type of full ceramic crown they received: Group A: Feldspathic Cerec inLab ceramic system, Group B: Cerec inLab aluminum oxide ceramic system and Group C: Lithium disilicate press ceramic system. Before cementation, five crowns from each group were scanned using micro-CT in two sections, sagittal and coronal, to determine the MG and MD values for four regions of the crown (sagittal buccal, sagittal lingual, coronal mesial and coronal distal). After cementation and thermal cycling, the scanning was repeated. Measurements were obtained from 10 points for each region, 80 points totally, to evaluate the MG and MD values. Files were processed using NRecon and CTAn software. Results were statistically analyzed using one- and two-way ANOVA and Tukey HSD tests (P = 0.05).

Results:

Full ceramic systems showed clinically acceptable marginal adaptation values. The Feldspathic Cerec inLab ceramic system generally presented the lowest variance, except in the MG values of the coronal mesial region. The MG and MD values of all ceramics increased significantly after cementation, except in the shoulder preparation design (sagittal buccal region) for MG and in the chamfer preparation design (sagittal lingual region) for MD values.

Conclusions:

Full-ceramic crowns showed clinically acceptable marginal adaptation values. The Feldspathic Cerec inLab ceramic system (Vitablocs Mark II) generally presented the lowest variance when compared with the other ceramics, except for the MG values on the mesial surface of the coronal section.

In vitro evaluation of the internal and marginal misfit of CAD/CAM zirconia copings

STATEMENT OF PROBLEM

The constant updating of computer-aided design/computer-aided manufacture (CAD/CAM) systems and the introduction of new systems confirm the need for scientific evidence on internal and marginal adaptation.

PURPOSE

The purpose of this in vitro study was to measure and compare the degree of internal and marginal misfits of zirconia single-unit copings made by using 3 different CAD/CAM systems (Ceramill, Lava 3M, and Neoshape).

MATERIAL AND METHODS

Twenty-four anatomic prefabricated abutments (Neodent) were used to fabricate zirconia copings in Ceramill (n=8), Lava (n=8), and Neoshape (n=8). All copings were cemented and cut with a precision cutting machine to obtain 5 surfaces (mesial, distal, buccal, palatal, and incisal) and angle regions (internal axiogingival and axioincisal angles). Measurements were obtained from images at a magnification of ×100 and ×200 made with a digital camera attached to an optical microscope and adapted with a measuring device. The data were statistically analyzed with the 2-way ANOVA and Tukey honestly significant difference tests (α=.05).

RESULTS

In the internal misfit evaluation, the mean values observed for Ceramill, Lava, and Neoshape were palatal surface 76.5, 65.5, and 77.7 μm (P=.003); angle regions 69.4, 68.6, and 74.5 μm (P=.010); incisal surface 127.7, 97.2, and 182.2 μm (P<.001); and overall mean 72.1, 69.4, and 76.4 μm (P=.003). Significant differences were not found for mesial, distal, or buccal surfaces (P>.05). In the evaluation of marginal misfit (marginal discrepancy and absolute marginal discrepancy), the mean values found were 40.9 and 65.8 μm for Ceramill, 34.2 and 70.0 μm for Lava, and 39.3 and 74.5 μm for Neoshape. No significant differences were found among the 3 systems (P>.05).

CONCLUSIONS

Although the Lava system showed a significantly lower value of internal misfit than the Neoshape system, all systems showed clinically acceptable marginal misfit values.

Fit of CAD/CAM Implant Frameworks: A Comprehensive Review

Computer-aided design and computer-aided manufacturing (CAD/CAM) is a strongly emerging prosthesis fabrication method for implant dentistry. Currently, CAD/CAM allows the construction of implant frameworks from different materials. This review evaluates the literature pertaining to the precision fit of fixed implant frameworks fabricated by CAD/CAM. Following a comprehensive electronic search through PubMed (MEDLINE), 14 relevant articles were identified. The results indicate that the precision fit of CAD/CAM frameworks exceeded the fit of the 1-piece cast frameworks and laser-welded frameworks. A similar fit was observed for CAD/CAM frameworks and bonding of the framework body to prefabricated cylinders. The influence of CAD/CAM materials on the fit of a framework is minimal.