Evaluation of the marginal fit of a zirconia ceramic computer-aided machined (CAM) crown system

Evaluation of fit and accuracy of single crowns fabricated from self-glazed zirconia compared with milled zirconia

STATEMENT OF PROBLEM

Self-glazed zirconia is a novel dental material fabricated with a combination of subtractive and additive manufacturing techniques. However, how the marginal and internal fit of these restorations compare with conventionally fabricated zirconia is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal and internal fit and internal accuracy of single crowns made from self-glazed zirconia compared with those made from milled zirconia.

MATERIAL AND METHODS

A metal die was scanned, and a crown was designed using a computer-aided-design program. The computer-aided-manufacturing milling method (conventional technique) was used to produce 10 zirconia crowns, and additive manufacturing was used to produce 10 self-glazed zirconia crowns. Internal and marginal fit measurements were made by using the silicone replica method; marginal fit was also measured by using the direct-view technique. An independent t test was performed to compare both types of crowns and test the null hypothesis (α=.05).

RESULTS

For the occlusal, internal, and total mean distances, significant differences were found between self-glazed and milled zirconia crowns (P<.001). With the direct-view technique, a significant difference (P=.004) between the 2 techniques was found in the marginal area. The accuracy for the axial and occlusal areas combined for self-glazed and milled zirconia was 27 μm and 49 μm, respectively.

CONCLUSIONS

Both techniques produced crowns with clinically acceptable marginal and internal fit. The self-glazed zirconia crowns had higher accuracy of internal fit than milled zirconia crowns.

Effect of connector height and retainer occlusal thickness on the fracture resistance of posterior 4-unit monolithic 5Y-TZP fixed partial dentures after thermomechanical aging

STATEMENT OF PROBLEM

The connector height and retainer occlusal thickness of fixed partial dentures (FPDs) may affect restoration longevity.

PURPOSE

The purpose of this in vitro study was to determine and compare the fracture resistance of 4-unit monolithic 5% yttria tetragonal zirconia polycrystal (5Y-TZP) FPDs made with different connector heights and retainer occlusal thicknesses after thermomechanical aging.

MATERIAL AND METHODS

Forty test metal dies were duplicated from a master metal die containing 2 anatomic abutment preparations of the mandibular right first premolar and second molar for a 4-unit FPD. The dies were divided into 2 groups of 20 each for the fabrication of 4-unit FPDs, with 2-mm and 4-mm uniform connector heights at all 3 connectors, resulting in 6.3-mm2 and 12.6-mm2 connector areas. Each of these groups was further divided into 2 subgroups based on the occlusal thickness of the 2 retainers of 1 mm and 2 mm (n=10). Polyvinyl siloxane impressions of the test metal dies were made and poured in Type V dental stone. Laboratory scans were performed on all the stone dies, and 40 5Y-TZP FPDs (Ceramill Zolid FX) were designed and fabricated. Subsequently, all the FPDs were luted on to the metal dies with a self-adhesive resin cement. The FPDs were preloaded (400 000 mechanical cycles; 4000 thermocycles) using a mastication simulator and tested for axial compressive strength. Two-way analysis of variance (ANOVA) was used to examine the effect of connector and occlusal thicknesses on the fracture load (α=.05). The data were further assessed using the post hoc Tukey HSD multiple comparison test (α=.05).

RESULTS

The mean fracture load values were between 737 N and 1563 N. Significant differences in the mean fracture load were found between the connector heights (601 N; P<.001) and occlusal thicknesses (225 N; P=.002), but the interaction of the 2 factors was not significant (P=.132) The Tukey post hoc analysis showed significant differences between the connector thicknesses groups (P<.01), but the occlusal thicknesses were found to be similar for the same connector height (P=.609) CONCLUSIONS: Connector height and occlusal retainer thickness influenced the fracture load of 4-unit monolithic 5Y-TZP FPDs after thermomechanical aging.

Stereomicroscope-Based in Vitro Study Evaluating the Marginal and Internal Fit of PEEK and PEKK Crowns

Purpose

The aim of the in vitro study was to compare the internal merge and marginal perfection of polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) crowns under a stereomicroscope.

Methods

All-ceramic preparation is done on the maxillary first premolar which is mounted on the wax block which was scanned using 3Shape scanner and duplicated into 30 acrylic CAD/CAM dies (n = 15) for the placement of PEEK and PEKK crowns. The YENADENT milling system was used to fabricate 15 samples from Group A PEEK crowns and to fabricate 15 samples from Group B PEKK crowns. According to the manufacturer's instructions, an equal amount of the dual-cure resin luting agent (Rely X U200 Self-Adhesive resin, 3M, Germany) was dispensed on the mixing pad before being mixed with cement and painted on the internal surfaces of the copings with the finger pressure crowns which were luted. The values were then analyzed using one-way ANOVA (post hoc) followed by Dunnett's t-test.

Results

Among those two groups, PEEK group materials showed the lowest mean value of (28.73.3 ± 4.01) for marginal fit and (26.72 ± 2.53) for internal gap, whereas PEKK group showed a mean value of (32.85 ± 4.63) and (33.06 ± 4.14), respectively.

Conclusion

Among these two groups, comparatively less marginal fit and internal adaptation is seen in PEKK when compared to the PEEK crowns. While the marginal fit and internal adaptation of both PEEK and PEKK copings were in acceptable clinical range.

Fit analysis of stereolithography-manufactured three-unit resin prosthesis with different 3D-printing build orientations and layer thicknesses

STATEMENT OF PROBLEM

Printing conditions can affect the fit of a 3-dimensionally (3D) printed prosthesis. Therefore, it is important to determine the optimal printing conditions for stereolithography (SLA)-manufactured prostheses.

PURPOSE

The purpose of this study was to analyze the fit according to the build orientations and layer thicknesses in SLA-manufactured 3-unit resin prostheses.

MATERIAL AND METHODS

SLA 3D printed prostheses were produced in 5 build orientations (0, 30, 45, 60, and 90 degrees) and 2 layer thicknesses (50 and 100 μm). Milled prostheses were fabricated from the same design. The mounted prostheses on the master model were scanned with microcomputed tomography (μCT). Data were processed with the NRecon software program. For quantitative analysis, marginal and internal fits were measured by using the imageJ software program in terms of the following metrics: absolute marginal discrepancy, marginal gap, cervical area, midaxial wall area, line-angle area, and occlusal area. Internal gap volume was also measured with the CTAn software program. For statistical analysis, ANOVA and Tukey HSD tests were used (α=.05). For qualitative analysis, μCT cross-sections were compared among groups, and intaglio surfaces were imaged with a scanning electron microscope.

RESULTS

A layer thickness of 50 μm with build orientations of 45 and 60 degrees exhibited smaller mean gap values (P<.05) than the other conditions for all measurements except line-angle area and occlusal area. The scanning electron microscope images showed voids on the intaglio surfaces for the 0- and 90-degree groups.

CONCLUSIONS

For SLA 3D printed resin prostheses, a difference in fit occurred based on the printing conditions, although both 3D printed and milled prostheses showed a clinically acceptable fit. When an SLA 3D printed prosthesis is manufactured under appropriate conditions, a clinically acceptable fit can be obtained.

Impact of different CAD software programs on marginal and internal fit of provisional crowns: An in vitro study

Statement of the problem

Different CAD software programs used for designing crowns show variations in marginal and internal fit. Marginal and internal discrepancies may cause poorly fitting crowns.

Purpose

The aim of this study was to compare the marginal and internal fit of single crown temporary restorations designed using three different CAD software programs.

Materials and methods

Dentbird, Exocad and Inlab 20 were used to design temporary single crowns using the same cement gap. Three experimental groups (n = 10/group) were formed based on the CAD software used. Geomagic Control X three-dimensional analysis software was used to compare the marginal and internal fit among the groups. Measurements were obtained at nine different thickness points. IBM SPSS Statistics, version 22 was used for all statistical analyses.

Results

Among the CAD software programs tested, Dentbird produced the best internal fit on the buccal surface and the best marginal fit on both buccal and mesial surfaces. Exocad achieved the best values on the distal surface for both internal and marginal fit, while Inlab showed the best values on the mesial surface for internal fit and on the palatal surface for marginal fit.

Conclusions

The Dentbird CAD software program provided the most accurate fit values that closely matched the design. The marginal and internal fit oftemporary crowns may vary depending on the CAD software used.

Comparing the accuracy of crown fitting between milling and 3D printing techniques using CAD/CAM technologies

BACKGROUND

The accuracy of dental crowns is crucial for their longevity and effectiveness.

OBJECTIVE

This study aims to investigate how the precision of crowns is affected by two different fabrication methods, either subtractive (milling) or additive (3D printing), within computer-aided design/computer-aided manufacture (CAD/CAM) technology.

METHODS

A standardised digital scan of a maxillary first molar with a shoulder margin (.stl file) was used to design and fabricate crowns through both subtractive (milling) and additive (3D printing) processes. The crowns' marginal and internal fits were assessed comprehensively. Statistical analysis, including two-way ANOVA and independent t-tests, revealed significant differences in fitting accuracy between the two methods.

RESULTS

Crowns produced via 3D printing demonstrated superior fitting with minimal marginal (14 ± 5 μm) and internal discrepancies (22 ± 5 μm) compared to milling (marginal: 22 ± 4 μm, internal: 23 ± 3 μm), indicating a statistically significant advantage in precision (p⁢s⩽ 0.022 for marginal fit).

CONCLUSION

The findings suggest that 3D printing may offer a more accurate alternative to milling in the fabrication of digital dental prostheses, potentially revolutionising the field with its enhanced precision capabilities.

Marginal discrepancy of lithium disilicate crowns made with digital and conventional technologies

STATEMENT OF PROBLEM

Digital technologies have brought different workflows to prosthetic rehabilitations, but analyses of the available processes and their influence on the marginal fit of complete crowns are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal discrepancy of lithium disilicate complete crowns made with different workflows.

MATERIAL AND METHODS

Fifty lithium disilicate crowns were made with 5 different workflows (n=10): G1-Analog (control): conventional flow/pressed crown; G2-Hybrid: hybrid flow/milled crown; G3-Hybrid: hybrid flow/pressed crown; G4-Hybrid: hybrid flow/printed wax pattern/pressed crown; G5-Digital: digital flow/milled crown. The specimens were analyzed by scanning electron microscopy, and the data were analyzed for normality and submitted to analysis of variance (ANOVA). Multiple comparisons were made by using the Tukey HSD test (α=.05).

RESULTS

G4H (18.1 ±6.6 µm) had the lowest mean ±standard deviation marginal discrepancy values, statistically different from G2H (217.9 ±81.4 µm), G5D (236.4 ±89 µm), and G3H (661.8 ±61.9 µm) (P<.05). G3H had the highest marginal discrepancy values and were statistically similar to each other (P>.05). G1A (163.2 ±10.9 µm) had intermediate values, statistically similar to those of other groups (P>.05).

CONCLUSIONS

The conventional method showed no statistical differences in marginal discrepancy compared with methods using digital technology (scanner, software, 3D printer, or milling machine).

Effects of Surface Treatments and Cement Type on Shear Bond Strength between Titanium Alloy and All-Ceramic Materials

This study aimed to evaluate the effects of surface treatments and resin cement on the adhesion of ceramic and ceramic-like materials to titanium. A total of 40 specimens (5 mm diameter) of each material (lithium disilicate glass ceramic (LDGC-IPS e.maxCAD), lithium silicate glass ceramic (LSGC-VITA Suprinity) and a polymer-infiltrated ceramic network (PICN-Vita Enamic)) were fabricated using CAD/CAM technologies. In total, 120 titanium (Ti) specimens were divided into 12 groups, and half of the titanium specimens were tribochemically coated using CoJet. The titanium and all-ceramic specimens were cemented using either Self-curing adhesive cement (SCAC-Panavia 21) or a Self-curing luting composite (SCLC-Multilink Hybrid Abutment). After 5000 cycles of thermal aging, the shear bond strength (SBS) test was conducted using a universal testing machine. The failure modes of the specimens were analyzed using stereomicroscopy, and additionally, the representative specimens were observed using Scanning Electron Microscopy. ANOVA was used for the statistical analysis (p < 0.05). The post-hoc Duncan test was used to determine significant differences between the groups. The mean SBS values (mean ± STD) ranged from 15 ± 2 MPa to 29 ± 6 MPa. Significantly higher SBS values were acquired when the titanium surface was tribochemically coated (p < 0.05). The SCLC showed higher SBS values compared to the SCAC. While the LDGC showed the highest SBS values, the PICN presented the lowest. The tribochemical coating on the cementation surfaces of the titanium increased the SBS values. The specimens cemented with the SCLC showed higher SBS values than those with the SCAC. Additionally, the SCLC cement revealed a more significant increase in SBS values when used with the LDGC. The material used for restoration has a high impact on SBS than those of the cement and surface conditioning.

In Vitro Evaluation of marginal adaptation of polyether ether ketone and zirconia copings

Background

Polyether ether ketone (PEEK) has emerged as a new thermoplastic material with potential applications as a restorative material. Aim: This study aimed to evaluate the marginal adaptation of PEEK copings compared to zirconia copings using field emission scanning electron microscopy.

Materials and Methods

A freshly extracted maxillary central incisor was prepared for a full-coverage restoration following standard principles of tooth preparation. The tooth was sent to a laboratory for fabrication of samples using computer-aided design and manufacturing (CAD/CAM). Twenty samples of polyether ether ketone (PEEK) copings (group A) and 20 of zirconia copings were fabricated (group B). The copings were scanned under a field emission scanning electron microscope and measurements were taken at four distinct points. The marginal adaptation over the buccal, lingual, mesial, and distal margins for both groups was evaluated. One-way analysis of variance (ANOVA) and independent t test were applied.

Results

Our findings indicate that PEEK showed better marginal adaptation than zirconia at all measurement points. The mean marginal gap value of the PEEK group was 33.99 ± 8.81 μm and of the zirconia group was 56.21 ± 15.07 μm. On comparing marginal adaptation among the mesial, distal, buccal, and lingual aspects, PEEK showed better adaptation on all four margins, with the best adaptation on the buccal margin that had the lowest mean gap value of 29.27 ± 6.07 μm. The zirconia group adapted best at the distal margin, with a lowest mean gap value of 53.58 ± 15.25 μm (P ≤ 0.05).

Conclusion

PEEK copings had better marginal adaptation and fit compared to zirconia copings. It may have applications as a restorative material in fixed prostheses.

Evaluation of the virtual cement gap parameter of different CAD software programs in designing a single crown restoration: An in vitro study

STATEMENT OF PROBLEM

The accuracy of different virtual cement gap parameters in designing a single crown in a computer-aided design (CAD) software program is still unclear.

PURPOSE

The purpose of this in vitro study was to evaluate and compare the virtual cement gap settings of 3 different CAD software programs used to design a single crown restoration.

MATERIAL AND METHODS

Three different CAD software programs (exocad, Dental System, and B4D) were evaluated for designing single crowns with similar virtual cement gap settings. Three experimental groups were created based on the CAD software program used (n=10). Three-dimensional analysis software program was used to assess the virtual cement gap in the CAD restoration. The Shapiro-Wilk test of normality was used. Comparisons were carried out by using 1-way ANOVA and the Scheffé post hoc test (α=.05).

RESULTS

The Dental System software program had the lowest statistical mean error values at both tooth margin (4.6 μm) and axial wall (1.5 μm), followed by B4D then exocad. At the occlusal surface, the lowest statistical mean error value of 5 μm was achieved by the Dental System followed by exocad then B4D.

CONCLUSIONS

Accuracy of the virtual cement gap parameter in single crown design varies based on the CAD software used. The highest accuracy was attained by the Dental System software program at all tooth surfaces, followed by B4D at the tooth margin and axial wall and by exocad at the occlusal surface.

Six-year clinical performance of lithium disilicate glass-ceramic CAD-CAM versus metal-ceramic crowns

PURPOSE

To assess the clinical performance of monolithic CAD-CAM lithium disilicate glass-ceramic (LDGC) crowns and metal-ceramic (MC) crowns provided by predoctoral students. This study also assessed the effects of patient and provider-related factors on their clinical performance as well as patient preference for these types of crowns.

MATERIALS AND METHODS

Twenty-five patients who received 50 crowns (25 LDGC CAD-CAM and 25 MC) provided by predoctoral students were retrospectively examined. LDGC CAD-CAM crowns were milled in-house using the CEREC Bluecam system and cemented with either RelyX Unicem or Calibra Esthetic resin cements. MC crowns were cemented with RelyX Unicem cement. Clinical assessment of the crowns and the supporting periodontal structures were performed following the modified California Dental Association (CDA) criteria. Patients' preference was recorded using a visual analog scale (VAS). The results were statistically analyzed using log-rank test, Pearson Chi-squared test and Kaplan-Meier survival analysis.

RESULTS

Twelve complications were observed in the MC crown group (9-esthetic, 2-technical and 1-biological). In comparison, 2 complications in the LDGC CAD-CAM crown group were observed (1-technical and 1-esthetic). The 6-year cumulative survival rates for MC crowns and LDGC CAD-CAM were 90.8% and 96%, respectively, whereas the success rates were 83.4% and 96%, respectively. Overall, patients preferred the esthetic outcomes of LDGC CAD-CAM crowns over MC crowns.

CONCLUSION

The high survival and success rates, low number of complications, and the high level of patients' acceptance of monolithic LDGC CAD-CAM crowns lend them well as predictable and viable alternatives to the "gold standard" MC crowns.

Clinical evaluation of marginal fit of uncemented CAD-CAM monolithic zirconia three-unit restorations in anterior areas, using scannable and conventional polyvinyl siloxane impression materials

BACKGROUND

The accuracy of impression techniques determines the marginal fit of fixed prostheses. Marginal accuracy plays a main role in the success and failure of treatments. This in-vivo study evaluated the marginal fit of anterior three-unit monolithic zirconia fixed partial dentures (FPDs) using conventional and scannable polyvinyl siloxane impression materials.

METHODS

Ten patients were selected to replace the lateral teeth with a three-unit monolithic zirconia bridge. For each patient, in the first group, an impression was made with a two-step putty-wash technique using scannable polyvinyl siloxane material (BONASCAN; DMP, Greece). In the identical session, as the second group, an impression of conventional putty-wash polyvinyl siloxane was taken (BONASIL A⁺ Putty; DMP, Greece). The marginal discrepancy was measured through the replicas, which were cut perpendicularly within the buccolingual and mesiodistal directions. An Independent t-test was employed for data analyses (P < 0.05).

RESULTS

The marginal discrepancy in a conventional method for central abutment in mid-buccal, mid-lingual, mid-mesial, and mid-distal was higher than in the scannable method but it was not significant (P > 0.05). Also, the marginal discrepancy for canine abutment in the conventional method was higher than in the scannable method, but it was not significant, either (P > 0.05).

CONCLUSIONS

FPDs fabricated from both scannable and conventional impression materials were not superior to each other in marginal fit for both central and canine abutments by evaluation using the replica technique.

Marginal adaptation of CAD-CAM and heat-pressed lithium disilicate crowns: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Lithium disilicate crowns can be manufactured by computer-aided design and computer-aided manufacturing (CAD-CAM) or with the heat-pressed technique. The outcome of studies comparing the effect of the manufacturing method on the marginal adaptation of these crowns is not clear.

PURPOSE

The purpose of this systematic review and meta-analysis was to investigate the effect of the CAD-CAM system and pressing technique on the marginal adaptation of lithium disilicate crowns.

MATERIAL AND METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A literature research was conducted in MEDLINE via PubMed and Scopus databases, relevant journal sites, and the authors' collected references, from January 2009 to April 2019.

RESULTS

The electronic and manual searches that could be read in full totaled 24 studies; of which, 9 were included in the systematic review and meta-analysis, 7 of which were in vitro and 2 in vivo. Statistical analyses were conducted by using Review Manager software program. Meta-analyses were performed with the random effects model (α=.05). In vitro studies showed no difference in the manufacturing (P>.001; 95% confidence interval -0.687 to 0.632), and no significant difference was found for in vivo studies (P=.7, 95% confidence interval 0.00 to 54.77). In the joint analysis of the in vivo and in vitro articles, there was a significant difference between the manufacturing methods (P<.001).

CONCLUSIONS

Differences were detected between the marginal adaptation of lithium disilicate crowns fabricated with the CAD-CAM system and the pressing technique, but the accuracy values were clinically acceptable.

Clinical evaluation of 3D-printed zirconia crowns fabricated by selective laser melting (SLM) for posterior teeth restorations: Short-term pilot study

Background/purpose

Zirconia crowns (ZrC) without veneering porcelain have become an effective alternative in clinical practice. Monolithic zirconia restorations fabricated by the dry milling method do not have acceptable clinical properties. This study evaluated the periodontal qualities of three-dimensional printed ZrC using the modified United States Public Health Service (USPHS) criteria.

Materials and methods

A total of 15 patients who required dental crowns were recruited, and all 15 teeth were restored with digital 3D-printed ZrC. All crowns were assessed at the time of crown placement and 2, 6, and 24 weeks post-placement. Clinical parameters, including plaque index, gingival index, probing depth, crown marginal integrity, and attrition of the antagonist's teeth, were evaluated and recorded.

Results

According to the Modified California Dental Association quality evaluation system, 100% of the crowns received satisfactory grades. Despite the significant increase in plaque index and gingival index at two weeks post-ZrC placement, there was no deterioration in probing depth. Moreover, there was discard usage of ZrC on the antagonist's teeth at 24 weeks posttreatment. Of the 15 crowns, one tooth had to be extracted due to a vertical root fracture. Overall, the digital 3D-printed crowns showed no adverse effects on periodontal tissues after 24 weeks of follow-up.

Conclusion

The 3D-printed ZrC showed no periodontal problems. It can serve as an alternative for patients, particularly those with high esthetic expectations.

Marginal and Internal Misfit of Occlusal Veneers Made in Resin-matrix Ceramics

Objective

Considering that misfit is a significant predictor of the clinical success of indirect restorations, the objective of this study was to evaluate the marginal and internal misfit of two computer-aided design and manufacturing (CAD/CAM) RMC ceramic materials used as occlusal veneers (OVs) of different thicknesses.

Methods and Materials

A CAD model of a mandibular first molar was obtained and OV preparations 0.5-, 1.0-, and 1.5-mm thick were modeled and milled in two different materials (n=10/group): resin nanoceramic (RNC) and polymer-infiltrated ceramic network (PICN). Using the same CAD model, tooth preparations were milled in fiber-reinforced epoxy resin (n=20/thickness). The marginal and internal misfit of the restorations was assessed by X-ray microtomography. The measurements of the marginal gap (MG) and absolute marginal discrepancy were performed in two locations on each slice, whereas internal gap (IG) measurements were performed at ten locations on each slice. The data obtained were analyzed using two-way analysis of variance and Tukey post-hoc tests (α=0.05).

Results

No significant effect was attributable to the material type or material–thickness interaction for the MG, absolute marginal discrepancy (AMD), or IG (p&gt;0.05). However, the thickness significantly affected the IG of the restorations (p&lt;0.05). CAD/CAM RNC and PICN systems presented similar MG and AMD for OVs 0.5-, 1.0-, and 1.5-mm thick. However, the IG varied between thicknesses.

Surface roughness and marginal adaptation of stereolithography versus digital light processing three-dimensional printed resins: An in-vitro study

Aim

The aim of this study was to assess surface roughness and marginal adaptation of Stereolithographic versus Digital Light Processed three-dimensional (3D) printed provisional resins.

Materials and Methods

A 3-unit fixed partial denture (FPD) preparation was done on ideal model irrespective to 44-46. The Model was scanned and a 3-unit FPD was designed using 3-shape software. The STL file was transferred to two different 3D printers - Sprintray digital light processing (DLP) and Formlabs stereolithography (SLA). Eight samples were printed per group (total of 16 samples) using C and B temporary tooth-colored resin and cured according to the manufacturer's instructions. Marginal adaptation was checked for six surfaces per tooth for all the samples using a stereomicroscope. Surface roughness was also calculated for four samples from each group before and after polishing (pumice slurry + rouge and cotton buff) using a contact profilometer.

Results

The mean maximum marginal gap overall, was seen for the DLP group on the mesiobuccal surface of the first premolar, i.e., 178.8 ± 8.35 μm, while the minimal marginal gap was seen for the SLA group on the mesiolingual surface of first molar - 32.5 ± 7.07 μm. Furthermore, all the DLP samples showed a statistically significant higher mean marginal gap as compared to SLA samples (P < 0.005). All the samples showed surface roughness within the acceptable range. There was a statistically significant difference noted in Rz (roughness depth) before and after polishing (P < 0.05).

Conclusion

3D printed temporary resin FPD via SLA showed a much better marginal adaptation (49.6 μm mean marginal gap for 46 and 106.8 μm for 44) as compared to those printed via DLP (101.8 μm mean marginal gap for 46 and 157.5 μm for 44). All the samples showed an acceptable surface roughness.

Clinical Relevance

3D printed temporaries have shown good marginal fit and adaptation and are a viable choice in patients where temporaries has to be given for long term before a final prosthesis can be fabricated (especially for full mouth rehabilitations).

Evaluating the accuracy of three intraoral scanners using models containing different numbers of crown-prepared abutments

Background/purpose

The scanning accuracy of intraoral scanners’ data collection plays a key role in the success of the final treatment. However, few studies start from scanning technology itself to directly evaluate it. The aim of this study was to evaluate the scanning accuracy of three intraoral scanners, to provide a reference for relevant research and clinical applications.

Materials and methods

Six types of resin models containing different numbers of crown-prepared abutments were three-dimensionally printed, and a model scanner, as well as three intraoral scanners, were used to digitally scan the six models. The obtained data were uploaded to three-dimensional reverse software for registration and comparison, and the accuracy of the models were analyzed.

Results

When scanning the six groups of models, the Omnicam outperformed both the TRIOS and iTero in terms of accuracy in all groups except the second molar group. The TRIOS and iTero scanners also exhibited decreased degrees of accuracy when scanning the long dental arch. The accuracy decreased as the scanning scope increased; however, the Omnicam scanner exhibited a relatively high degree of accuracy when scanning the three-unit fixed bridge and anterior areas. All scanners exhibited the lowest degree of accuracy when scanning the full-arch model. Certain deviations were observed, and the scanning areas at the incisal edges of the anterior teeth and end of the dental arch exhibited relatively large deviations.

Conclusion

With the model scanner data as reference, the scanning accuracy of the three scanners exhibited differences and certain deviations, which were within clinical tolerance.

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.

Effect of Die Materials on Marginal and Internal Adaptation of Zirconia Copings: An In Vitro Study

Aim:

Close adaptation of cemented CAD/CAM restorations to their abutments is highly dependent on precise impressions and accurate replicas of teeth and adjacent oral tissues. This in-vitro study compared the effect of two die materials, as physical replicas of prepared teeth, on internal and marginal adaptations of zirconia copings to their corresponding abutments.

Materials and Methods:

A virtual model simulating a prepared premolar was designed and used for the milling of thirty identical metal models. Impression was taken of all models by Polyvinyl siloxane material. Fifteen impressions were poured in with Type IV stone and the other fifteen with polyurethane resin to make dies. All dies were scanned, and for each of them, zirconia coping was designed and milled. The copings were cemented to their corresponding metal models. Marginal gap between each coping and its metal model was measured at 20 points with a stereomicroscope (×60). Then the specimens were sectioned into two halves, and the internal gap was measured at seven points, including right and left cervico-axial, mid-axial, occluso-axial, and mid-occlusal. The data were analyzed with an independent T-test and repeated measure ANOVA at a 95% confidence level (p<0.05).

Results:

Mean value of marginal gap for Type IV stone and Exakto-Form groups were 54.31 ± 4.11 μm and 56.25 ± 4.24 μm, respectively. Mean values of the internal gaps for both groups ranged from 48 μm to 120 μm.

Conclusion:

Based on the results of this study, an internal and marginal adaptation of zirconia copings designed on digitized polyurethane and Type IV stone dies are clinically acceptable.

Effect of Finish Line Design on the Fit Accuracy of CAD/CAM Monolithic Polymer-Infiltrated Ceramic-Network Fixed Dental Prostheses: An In Vitro Study

A polymer-infiltrated ceramic network (PICN) material has recently been introduced for dental use and evidence is developing regarding the fit accuracy of such crowns with different preparation designs. The aim of this in vitro study was to evaluate the precision of fit of machined monolithic PICN single crowns in comparison to lithium disilicate crowns in terms of marginal gap, internal gap, and absolute marginal discrepancies. A secondary aim was to assess the effect of finish line configuration on the fit accuracy of crowns made from the two materials. Two master metal dies were used to create forty stone dies, with twenty each for the two finish lines, shoulder and chamfer. The stone dies were scanned to produce virtual models, on which ceramic crowns were designed and milled, with ten each for the four material–finish line combinations (n = 10). Marginal gaps and absolute marginal discrepancies were evaluated at six pre-determined margin locations, and the internal gap was measured at 60 designated points using a stereomicroscope-based digital image analysis system. The influence of the material and finish line on the marginal and internal adaptation of crowns was assessed by analyzing the data using two-way analysis of variance (ANOVA), non-parametric, and Bonferroni multiple comparison post-hoc tests (α = 0.05). ANOVA revealed that the differences in the marginal gaps and the absolute marginal discrepancies between the two materials were significant (p < 0.05), but that those the finish line effect and the interaction were not significant (p > 0.05). Using the Mann–Whitney U test, the differences in IG for ‘material’ and ‘finish line’ were not found to be significant (p > 0.05). In conclusion, the finish line configuration did not seem to affect the marginal and internal adaptation of PICN and lithium disilicate crowns. The marginal gap of PICN crowns was below the clinically acceptable threshold of 120 µm.

Comparison of Marginal Fit and Internal Adaptation of Copings Fabricated with Polyetheretherketone and Zirconia - An In vitro Study

Context:

Purpose: The aim of this in vitro study was to evaluate and compare the Marginal fit and Internal adaptation of copings fabricated with polyetheretherketone (PEEK) and Zirconia luted with resin cements.

Materials and Methods:

Maxillary first premolar was prepared to receive all ceramic restoration. It was duplicated using addition silicon impression material for fabricating Cobalt–Chromium metal die, which is used as a master die. Using the master die, 30 heat cure acrylic samples were fabricated for the heat cure acrylic tooth models on which 15 PEEK and 15 zirconia copings were made. Self-adhesive resin cement is used for luting and 30 copings were luted. After 24 h, luted copings were having a disc of thickness 0.01 mm cutting at high speed using a Tooth cutting lathe for all the 30 samples. Field Scanning Electron Microscopic study analysis for evaluating marginal fit and internal adaptation of two groups were observed. The values were then analyzed using one-way ANOVA (post hoc) followed by Dunnet t-test.

Results:

Among those two groups, PEEK copings group materials showed the lowest mean value of (30.3 ± 5.1) for marginal gap, (29.1 ± 5.8) for internal gap whereas the zirconia copings group showed a mean value of (50.26 ± 16.02) and (32.8 ± 5.2) respectively.

Conclusion:

Among these two groups, comparatively less marginal fit and internal adaptation is seen in zirconia copings when compared to the PEEK copings. While the marginal fit and internal adaptation of both PEEK and zirconia copings were in the acceptable clinical range.

Evaluation of Marginal/Internal Fit and Fracture Load of Monolithic Zirconia and Zirconia Lithium Silicate (ZLS) CAD/CAM Crown Systems

Fit accuracy and fracture strength of milled monolithic zirconia (Zi) and zirconia-reinforced lithium silicate (ZLS) crowns are important parameters determining the success of these restorations. This study aimed to evaluate and compare the marginal and internal fit of monolithic Zi and ZLS crowns, along with the fracture load, with and without mechanical aging. Thirty-two stone dies acquired from a customized master metal molar die were scanned, and ceramic crowns (16 Zi Ceramill Zolid HT⁺ and 16 ZLS Vita Suprinity) were designed and milled. Absolute marginal discrepancies (AMD), marginal gaps (MG), and internal gaps (IG) of the crowns, in relation to the master metal die, were evaluated using x-ray nanotomography (n = 16). Next, thirty-two metal dies were fabricated based on the master metal die, and crowns (16 Zi; 16 ZLS) cemented and divided into four groups of eight each; eight Zi with mechanical aging (MA), eight Zi without mechanical aging (WMA), eight ZLS (MA), and eight ZLS (WMA). Two groups of crowns (Zi-MA; ZLS-MA) were subjected to 500,000 mechanical cycles (200 ± 50 N, 10 Hz) followed by axial compressive strength testing of all crowns, until failure, and the values were recorded. Independent sample t tests (α = 0.05) revealed no significant differences between Zi and ZLS crowns (p > 0.05); for both internal and marginal gaps, however, there were significant differences in AMD (p < 0.005). Independent samples Mann–Whitney U and Kruskal–Wallis tests revealed significant differences between the two materials, Zi and ZLS, regardless of fatigue loading, and for the individual material groups based on aging (α = 0.05). Multiple comparisons using Bonferroni post-hoc analysis showed significant differences between Zi and ZLS material groups, with or without aging. Within the limitations of this study, the ZLS crown fit was found to be on par with Zi, except for the AMD parameter. As regards fracture resistance, both materials survived the normal range of masticatory forces, but the Zi crowns demonstrated greater resistance to fracture. The monolithic Zi and ZLS crowns seem suitable for clinical application, based on the fit and fracture strength values obtained.

Removable partial dentures retained by hybrid CAD/CAM cobalt-chrome double crowns: 1-year results from a prospective clinical study: CAD/CAM cobalt-chrome double crowns: 1-year results

OBJECTIVES

Computer-aided design and manufacturing (CAD/CAM) has been successfully used to replace conventional steps in the fabrication of double crowns, creating hybrid-workflows that might facilitate the wider application of these restorations in the future. However, in-vivo data are still lacking.

METHODS

A prospective clinical trial was designed in which 20 patients (median age = 69 years; n women = 10) with 73 abutment teeth who needed a double-crown-retained removable partial denture (RPD) were consecutively recruited. While most of the work steps were done conventionally, gypsum models were digitized with a laboratory scanner to allow CAD/CAM fabrication of primary crowns and secondary structures. DentalDesigner software (3Shape) was used in combination with milling unit PrograMillPM7 and Co-Cr- blanks (Ivoclar-vivadent). Connectors were milled from wax, transferred to Co-Cr using lost-wax technique and bonded to the secondary crowns. Clinical follow-ups were scheduled 6 and 12 months after prosthesis insertion. Outcome parameters were complication-free survival of RPDs and abutment teeth after one year.

RESULTS

After 12 months, complication-free survival was 74% and 91% for the RPDs and abutment teeth, respectively. Complications comprised decementations (n = 5), abutment tooth fractures (n = 2), fracture of denture teeth (n = 1), and loss of abutment teeth (n = 1). These complications were easily manageable, resulting in 1-year survival of 100% for CAD/CAM RPDs.

CONCLUSIONS

First data on short-term complication rates of CAD/CAM double-crown-retained RPDs appear promising. To gather further evidence, prospective clinical trials over a longer follow-up time and with larger patient groups are required.

CLINICAL SIGNIFICANCE

Hybrid CAD/CAM double-crown retained RPDs showed a successful clinical application after one year of follow-up. Further research is needed to evaluate their performance in comparison to conventional manufacturing methods.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

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.

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

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

Marginal and Internal Precision of Zirconia Four-Unit Fixed Partial Denture Frameworks Produced Using Four Milling Systems

Background: CAD/CAM systems enable the production of fixed partial dentures with small and reproducible internal and marginal gaps. Purpose: The purpose of this study was to evaluate the reproducibility of the marginal and internal adaptations of four-unit fixed partial denture frameworks produced using four CAD/CAM systems. Materials and Methods: Prepared dies of a master model that simulated the loss of the first left molar were measured. Fifteen frameworks were manufactured using four CAD/CAM systems (A–D). The internal fit was determined by the replica technique, and the marginal gap was determined by microscopy. ANOVA was carried out to detect significant differences, and the Bonferroni adjustment was performed. The global level of significance was set at 5%. Results: The mean gap size ranged from 84 to 132 µm (SD 43–71 µm). The CAD/CAM systems showed significant variance (p < 0.001), and system A (VHF) showed the smallest gaps. The smallest gaps for each system were in the molar part and in the marginal region of the frameworks (p < 0.001). Conclusions: The CAD/CAM systems showed significantly different gap sizes, particularly between premolars and molars and among the marginal, axial and occlusal regions. All of the systems are suitable for clinical application.

The marginal and internal discrepancy of zirconia coping milled by two computer-aided design-computer-aided manufacturing systems

Aims:

This study aimed to evaluate the marginal and internal discrepancy of the zirconia coping fabricated by two dental computer-aided design–computer-aided manufacturing (CAD-CAM) systems.

Settings and Design:

In vitro comparative study.

Materials and Methods:

Twenty zirconia crowns fabricated from inCoris ZI by Cerec InLab CAD-CAM system (Dentsply Sirona Inc, USA) and Ceramill ZI by Ceramill CAD-CAM system (Amann Girrbach, Austria) were measured the discrepancy at six locations using silicone replica technique. Absolute marginal discrepancy (AMD) and marginal gap (MG) represent the marginal discrepancy, and the other four locations at chamfer area, axial wall, cusp tip, and occlusal adaptation represent the internal discrepancy. The gap was measured using an optical light microscope at ×50 magnification.

Statistical Analysis Used:

The data were analyzed using two-way ANOVA and Game–Howell post hoc test.

Results:

The statistical analysis showed that the accuracy of zirconia coping depends on CAD-CAM system and the location of measurement. Cerec InLab showed the marginal discrepancy of the coping 119.5 ± 44.8 μm at MG position and 125.3 ± 36.6 μm at AMD position, which was statistically larger than Ceramill system did at 53.0 ± 12.1 μm and 67.2 ± 19.1 μm. On the other hand, the discrepancy in other positions showed no statistical difference between the two CAD-CAM systems.

Conclusions:

The accuracy of zirconia coping was significant affected by CAD-CAM system and the location of measurement.

Effect of virtual cement gap settings on the marginal fit of cemented resin-ceramic crowns on implant abutments

STATEMENT OF PROBLEM

Agreement on the perfect virtual cement space value for computer-aided design and computer-aided manufacturing (CAD-CAM) implant-supported resin-ceramic crowns with the best marginal adaptation is lacking. The range of cement gap settings in some CAD design software programs is wide (0 to 200 μm), and manufacturer recommendations regarding the best cement gap setting for certain types of ceramics is not specific.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of virtual cement gap settings on the marginal fit of cemented resin-ceramic crowns on implant abutments.

MATERIAL AND METHODS

Thirty implant analogs and matching stock abutments were coupled and implanted into autopolymerizing acrylic resin blocks. Three groups (n=10) of resin-ceramic molar crowns with 3 different virtual cement space settings (40, 60, and 100 μm) were designed by using a CAD design software program. The crowns were cemented over their corresponding abutments under a static load by using a specially designed cementing device. A scanning electron microscope was used to measure the mean vertical marginal gap (MG) for each group, where a total of 120 measurements for each of the 3 groups (12 sites per crown and 10 crowns per group) were evaluated. One-way analysis of variance and the post hoc Tukey pairwise comparison tests were used to analyze the data (α=.05).

RESULTS

A significant difference (P<.001) was found between the MG values of the resin-ceramic implant-supported crowns fabricated by using the 3 cement space settings. The smallest MG was obtained with the 60-μm setting as compared with the 40-μm and 100-μm settings.

CONCLUSIONS

A limited inverse relation was found between the MGs of CAD-CAM-fabricated resin-ceramic implant-supported crowns and the cement gap settings in the exocad software program. The smallest MGs were obtained when a 60-μm cement space value was used (P<.001).

Correlation between 2D and 3D measurements of cement space in CAD-CAM crowns

STATEMENT OF PROBLEM

Although the 2D analysis of prosthesis cementation space has been popular, its correlation with volumetric comparison (3D data) of cement space is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the cement space in computer-aided design and computer-aided manufacturing (CAD-CAM) crowns of different materials and correlate 2D measurements of cement space with their corresponding 3D values (volume of cement space) by using microcomputed tomography (μCT) analysis of regions of interest.

MATERIAL AND METHODS

Ten molar crowns were milled in lithium disilicate (LD), resin nanoceramic (RN), and zirconia (Z) ceramics. Silicone replicas were produced and used as the analog cement layer and scanned with a desktop X-ray microfocus CT scanner. Twenty-eight slices were evaluated in 3 regions: marginal, axial, and occlusal (n=84 measurement points/specimen). After 3D reconstruction of the cement space, the volume was calculated. Data were statistically evaluated through 2-way ANOVA and Bonferroni test (α=.05). The Pearson correlation test was used to investigate the correlation between the 2D and 3D data.

RESULTS

The volumes of the occlusal (LD 10 ±1 mm³; RN 9 ±1 mm³) and axial regions (LD 9 ±2 mm³; RN 8 ±1 mm³) were significantly higher than the volume of the marginal region for LD and RN specimens (LD 6 ±2 mm³; RN 4 ±1 mm³) (both P<.001). For the Z group, the axial region had the highest volume (19 ±2 mm³), followed by the volumes of the occlusal (15 ±1 mm³) and marginal regions (12 ±1 mm³). The Pearson correlation test determined a moderate positive correlation of the marginal area (r=0.606, P<.001) and of the axial region (r=0.588, P<.001). However, a moderate negative correlation was found between volume and thickness of the occlusal area (r=-0.437, P=.016).

CONCLUSIONS

Z showed more volume of cement space, as well as thicker cement space than LD and RN. The μCT analysis is an efficient method of analyzing cement thickness and volume in ceramic crowns at the selected regions of interest. A moderate positive correlation was found between the 2D and 3D analyses for the axial and marginal regions of ceramic crowns.

Evaluation of Internal Fit and Marginal Adaptation of Provisional Crowns Fabricated with Three Different Techniques

Different techniques have been used to construct provisional crowns to protect prepared teeth. The purpose of this in vitro study was to assess the internal fit and marginal discrepancy of provisional crowns made by different methods. A total of 48 provisional crowns were constructed and divided into three groups (n = 16) according to the fabrication methods: fabricated manually-group MAN; computer-aided design/computer aided manufacturing technology-group CAM; and 3-dimensional (3D)-printed technology-group 3DP. The same standard tessellation language (STL) file was used for both CAD/CAM and 3D-printed group. The silicone-checked method was used to measure the internal gap distance. The marginal discrepancy was measured by using the polyvinyl siloxane (PVS) replica method and swept-source optical coherence tomography (OCT) scanning technique. Data were analyzed with one-way analysis of variance (ANOVA) nonparametric Kruskal-Wallis and Tukey tests at α = 0.05. At the central pit and axial walls, the gap distance mean values of group CAM were higher than those from group MAN and 3DP. The group 3DP was statistically significantly higher in gap distance at the location of occlusion than group MAN and group CAM (p < 0.05). The total gap distances assessed by silicone-checked method revealed there were no statistically significant differences between the tested groups (p > 0.05). The total mean values of absolute and horizontal marginal discrepancy of the group 3DP obtained by using the PVS-replica method and OCT scanning technique were significantly higher than the group MAN and CAM (p < 0.05). Regression correlation results of marginal discrepancy indicated a positive correlation (r = 0.902) between PVS-replica method and OCT scanning technique. The manually fabricated provisional crowns presented better internal fit and a smaller marginal discrepancy. Between different assessment techniques for marginal adaptation, PVS-replica method and OCT scanning technique have a positive correlation.

Comparison of Marginal Adaptation of Different Resin-Ceramic CAD/CAM Crowns: An In Vitro Study

Aim:

To compare the marginal adaptation of crowns fabricated by using three different resin-ceramic computer-aided design/computer-aided manufacturing (CAD/CAM) materials.

Materials and Methods:

Crowns fabricated from three different resin-ceramic CAD/CAM blocks, applied on a typodont premolar (#14), were tested with regard to marginal adaptation, in this in vitro study. The typodont maxillary first premolar was prepared to serve as the master die and digitized with an intraoral scanner. The same virtual crown design was used to fabricate all specimens. Forty-eight crowns were fabricated from the same virtual crown design using three different CAD/CAM resin-ceramic blocks as follows ( n = 16): Lava Ultimate (LU), GC Cerasmart (GC), Vita Enamic (VE). Master die and crowns were scanned with a laboratory scanner and three-dimensional data were transferred into three-matic software. The software calculated the mean of the marginal discrepancy (MD) for each crown in negative and positive values, representing under and over estimation of the crown margin, respectively. A marginal discrepancy index (MDI) was obtained for each group using negative and positive MDs. All data were statistically analyzed using one-way analysis of variance and Tukey’s honest significance test ( α = 0.05).

Results:

The analysis of variance showed no statistical differences between materials regarding the negative and positive MDs ( P > .05). The MDI for LU was lower than GC and VE ( P < .05).

Conclusion:

The marginal adaptation of different resin-ceramic materials was different with regard to MDI values. Nevertheless, the MD values of all groups were within the clinically acceptable range.

Clinical Evaluation of Time Efficiency and Fit Accuracy of Lithium Disilicate Single Crowns between Conventional and Digital Impression

The purpose of this study was to demonstrate the time-efficiency and the clinical effectiveness of chairside-fabricated lithium disilicate single crowns by digital impressions compared to the conventional method. Thirteen patients requiring a single crown on the maxillary or mandibular premolar or first molar were assigned as study subjects. The impressions were obtained using the conventional method and two digital methods with intraoral scanners: AEGIS.PO (Digital Dentistry Solution, Seoul, Korea) and CEREC Omnicam (Sirona, Bensheim, Germany). Two types of lithium disilicate single crowns were obtained; a reference crown (by conventional workflow) and a chairside crown (by digital workflow). The total time taken for fabricating the chairside crown was recorded. The replica technique was performed to compare the marginal and internal fit of the two types of crowns. In addition, accuracy of the intraoral scanners was evaluated by the best-fit alignment method. The difference between the groups was analyzed using the two-tailed paired t-test or one-way ANOVA, followed by the Student–Newman–Keuls test for multiple comparisons. Statistical significance was accepted at p < 0.05 for all statistical tests. The time required to obtain the impressions by the AEGIS (7:16 ± 1:50 min:s) and CEREC (7:29 ± 2:03 min:s) intraoral scans was significantly lower than the conventional method (12:41 ± 1:16 min:s; p < 0.001). There was no significant difference between the intraoral scanners. The total working time to fabricate the chairside crown averaged 30:58 ± 4:40 min:s. The average marginal gap was not significantly different between the reference (107.86 ± 42.45 µm) and chairside (115.52 ± 38.22 µm) crowns (p > 0.05), based on results of replica measurement. The average internal gaps were not significantly different. The average value of the root mean square between the AEGIS (31.7 ± 12.3 µm) and CEREC (32.4 ± 9.7 µm) scans was not significantly different (p > 0.05). Intraoral scans required a significantly shorter impression time than the conventional method, and it was possible to fabricate a lithium disilicate crown in a single visit. There were no statistically significant differences in the fit of the restorations and accuracy of the intraoral scanners compared to the conventional workflow.

Clinical evaluation of the fit of lithium disilicate crowns fabricated with three different CAD-CAM systems

STATEMENT OF PROBLEM

The fit and performance of prostheses fabricated using various computer-aided design and computer-aided manufacturing (CAD-CAM) systems have been evaluated. However, most studies were conducted in vitro, and relatively few have addressed gingival parameters and prosthesis fit under clinical conditions.

PURPOSE

This clinical study aimed to compare the fit of lithium disilicate crowns produced using 3 CAD-CAM systems and evaluate clinical results up to 6 months after delivery.

MATERIAL AND METHODS

Forty participants requiring a single crown were recruited. Three monolithic lithium disilicate crowns were fabricated per participant by using 3 different CAD-CAM systems (intraoral scanners, CAD software, and milling machines): CEREC group (CEREC Bluecam, CEREC AC, CEREC MC); EZIS group (EZIS PO, EZIS VR, EZIS HM); and TRIOS group (TRIOS 3, EXO-CAD, ARUM-4X). The fit of the prostheses was assessed via a silicone replica technique, and the most acceptable crown was delivered; 12 were selected from the CEREC group, 16 from the EZIS group, and 12 from the TRIOS group. Follow-up clinical examinations were performed at 1, 3, and 6 months after delivery. The Kruskal-Wallis test with the post hoc Mann-Whitney U test was conducted to analyze significant differences in crown fit and periodontal conditions among the groups (α=.05).

RESULTS

The marginal gap of the CEREC group was significantly higher than that of the EZIS group, and the occlusal gap of the EZIS group was significantly lower than those of the CEREC and TRIOS groups (P<.05). Probing depth, bleeding index, and plaque index showed no intergroup differences at 6 months (P>.05).

CONCLUSIONS

The lithium disilicate crowns of all groups showed clinically acceptable fit. No significant differences were found among the groups in terms of periodontal conditions after 6 months.

In Vitro Study of Comparative Evaluation of Marginal and Internal Fit between Heat-Pressed and CAD-CAM Monolithic Glass-Ceramic Restorations after Thermal Aging

The accuracy of newly developed ceramic materials is still being studied. Marginal and internal adaptation are known factors that have an essential impact on the long term success of dental restorations. The aim of this in vitro study was to evaluate the marginal and internal fit of heat-pressed and milled monolithic glass-ceramic restorations based on their ceramic type, processing technique, and in vitro thermocycling. Thirty-two crowns were studied and divided into four groups (n = 8), according to the ceramic material (feldspathic glass-ceramic (F) and zirconia reinforced lithium silicate glass-ceramic (ZLS)) and to their technological obtaining processes (milling (M) and heat-pressing (P)). A typodont preparation was scanned with a D2000 3D scanner to obtain identical 32 resin 3D-printed abutment teeth. Marginal and internal gaps were measured using the silicone replica technique under 40× magnification. The crowns were further cemented and thermally aged for 10,000 cycles After cementation and thermocycling of the samples, marginal and internal gaps were assessed using micro-CT (micro-computed tomography)) analysis. Data were statistically analyzed using statistical tests. Significant differences were found before and after cementation and thermocycling among the tested materials (p < 0.05). Related to technological processing, significant differences were seen in the marginal area between FP and FM (p < 0.05) Significant differences were also found in the axial and occlusal areas between the ZLSP and ZLSM. Thermocycling and cementation did not have a significant effect on the tested materials (p < 0.05). The technological processes influenced the marginal and internal fit of the crowns in favor of the CAD/CAM (computer aided design/computer aided manufacturing)technologies. Thermal aging had little effect on marginal adaptability; it increased the values for all the tested samples in a small way, but the values remained in their clinically acceptable range for all of the crowns.

Fit of tooth-supported zirconia single crowns-A systematic review of the literature

PURPOSE

The purpose of this study is to systematically map all the factors that influence the fit and adaptation of zirconia crowns and/or copings.

MATERIALS AND METHODS

The investigational strategy involved carrying out an electronic search between December 1, 2009 and September 1, 2019 through the Embase and Medline databases using Boolean operators to locate appropriate articles.

RESULTS

A total of 637 articles were discovered after the removal of duplicates, and 46 of these were selected for evaluation. Further, a quality assessment was performed using GRADE evaluation criteria.

CONCLUSIONS

Shoulder finish line preparations had slightly better marginal fit compared to chamfer finish lines. Crowns obtained from digital impressions had comparable to superior marginal adaptation compared to conventional impressions. Increasing cement space showed to improve zirconia crown adaptation. Cementation and veneering zirconia frameworks found to increase the marginal and internal gaps. Limited information is available on the effect of the alteration of sintering time/Temperature and/or sintering techniques on the adaptation of zirconia crowns. Most of the selected studies had a moderate quality assessment evaluation. Future studies could investigate the chair-side, ultra-fast sintering effect on the marginal gap of zirconia crowns.

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).

Influence of CAD/CAM Fabrication and Sintering Procedures on the Fracture Load of Full-Contour Monolithic Zirconia Crowns as a Function of Material Thickness

OBJECTIVE

The purpose of this in vitro study was to analyze the effect of computer-aided design/computer-aided manufacturing (CAD/CAM) fabrication and sintering procedures on the fracture load of monolithic zirconia crowns with different material thicknesses adhesively seated to methacrylate dies fabricated with stereolithography technology.

METHOD

Monolithic zirconia crowns were fabricated from inCoris TZI C material with a chairside CAD/CAM system (CEREC MCXL) comprising three material thicknesses (0.5/1.0/1.5 mm, n=8 each). Two CAD/CAM fabrication procedures (milling, MI; grinding, GR), two chairside sintering procedures (superspeed, SS; speedfire sintering, SF), and one labside sintering procedure (classic, CL) were evaluated. In total, 144 crowns were fabricated. Restorations were adhesively seated to methacrylate dies fabricated with SLA technology. Thermomechanical cycling (TCML) was performed before fracture testing. Loading forces until fracture were registered and statistically analyzed with one-way analysis of variance (ANOVA), post hoc Scheffé test, and three-way ANOVA (α=0.05).

RESULTS

Test groups showed statistically significant differences (p<0.05). The highest mean value was found for 1.5-mm crowns of group GR_SF with 3678.6 ± 363.9 N. The lowest mean value was found for group 0.5-mm crowns of group MI_SF with 382.4 ± 30.7 N. There was a significant three-way interaction effect between thickness, sintering, and processing [F(4,126)=9.542; p<0.001; three-way ANOVA, significance level α=0.05].

CONCLUSIONS

CAD/CAM fabrication and sintering procedures influence the maximum loading force of monolithic zirconia crowns with different material thicknesses. A material thickness of 0.5 mm should be considered as a critical thickness for monolithic zirconia crown restorations.

Marginal fit of CAD-CAM monolithic zirconia crowns fabricated by using cone beam computed tomography scans

STATEMENT OF PROBLEM

Information regarding the precision of monolithic zirconia crowns fabricated by using a standard computer-aided design and computer-aided manufacturing (CAD-CAM) workflow is available. However, information on the effect of a modified workflow using 3D laboratory scanning and/or cone beam computed tomography (CBCT) for monolithic zirconia crown fabrication is lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of different scans on the marginal fit of CAD-CAM monolithic zirconia crowns fabricated by 3D laboratory scanning and CBCT.

MATERIAL AND METHODS

An extracted maxillary left first molar was prepared and digitized by using a 3D laboratory scanner (D900; 3Shape A/S) (control group). The tooth was also scanned by CBCT (i-CAT; Imaging Sciences) to generate a second virtual 3D model (CBCTscan group). A tooth cast out of polyurethane (PU) (Zenotec Model; Wieland) was reproduced from the CBCT data by using a CAD software program (Dental System 2.6; 3Shape A/S) and milling machine (CORiTEC 550i; imes-icore) and further scanned by using the 3D laboratory scanner to generate a third virtual 3D model to represent a clinical scenario where a patient's cast is needed (PU3DLab group). A monolithic zirconia crown design (cement space: margin 40 μm, 1 mm above 70 μm) was used on the virtual models, and crowns were fabricated out of presintered zirconia blocks (ZenostarT4; Wieland) by using a 5-axis milling machine (CORiTEC 550i; imes-icore). The crowns were sintered (Sinterofen HT-S Speed; Mihm-Vogt), and the vertical marginal discrepancy (VMD) was measured by ×100-magnification microscopy. Measurements were made at 384 points in 3 groups of 16 specimens. The measurements for each specimen were averaged, and VMD mean values were calculated. The Kruskal-Wallis test was used for the statistical analysis (α=.05). The Mann-Whitney U test and Bonferroni adjustment were further used to compare the pairs (α=.017).

RESULTS

The mean VMD value was 41 μm (median: 38 μm) for the control group, 44 μm (median: 42 μm) for the CBCTscan, and 60 μm (median: 58 μm) for the PU3DLab. No significant difference was found between control and CBCTscan groups (P=.274). However, there was a significant difference between control and PU3DLab and CBCTscan and PU3DLab groups (P<.001).

CONCLUSIONS

Marginal fit of the crowns fabricated by using the 3D laboratory scanner and through the direct use of CBCT was better than that of the crowns fabricated by using the workflow that combined the use of CBCT, PU cast, and 3D laboratory scanner. All tested protocols enabled the fabrication of monolithic zirconia crowns with a marginal discrepancy smaller than 120 μm.

Digital microscopic evaluation of vertical marginal discrepancies of CAD/CAM fabricated zirconia cores

OBJECTIVE

The aim of this in vitro research study was to evaluate the vertical marginal discrepancies of zirconia (Zr) cores fabricated by five different computer-aided design and manufacturing (CAD/CAM) systems using a digital microscope.

MATERIALS AND METHODS

A total of 60 specimens were prepared and randomly divided into five groups (n=12 each) using the following systems: Ceramill Motion 2 (CM, Amanngirrbach, Germany); Weiland (WI, Ivoclar Vivadent, USA); Cerec (CS, Sirona Dental, USA); Zirkonzahn (ZZ, Gmbh Bruneck, Italy) and Cad4dent (CD, Canada). The specimens were numbered and the vertical marginal discrepancies were evaluated with a digital microscope at 50× magnification.

RESULTS

A one-way analysis of variance showed a statistically significant difference (p=0.002) between the groups. The CM group exhibited the lowest values for the marginal gaps (31.30±15.12 μm), while the ZZ group exhibited the highest values for the marginal gaps (44.83±28.76 μm) compared to other groups. A post hoc Tukey's test for multiple comparisons between the experimental groups showed a statistically significant difference (p<0.05) between the group CM and group CD with group ZZ. The rest of the groups showed no significant differences between them. Variations in the values were observed for the four sites measured with the highest and the least mean marginal gap value of 43.19±23.84 μm and 32.49±12.21 μm for buccal and lingual sites, respectively.

CONCLUSION

Variations existed in the marginal discrepancy values for the CAD/CAM systems investigated in the study. Vertical marginal discrepancy values observed for various systems investigated in the study were well within the clinically acceptable range.

Comparison of Overall Fit of Milled and Laser-Sintered CAD/CAM Crown Copings

Background and Aims

The aim of this study was to investigate the effect of computer-aided design/computer-aided manufacturing (CAD/CAM) procedures on the overall fit of metal copings.

Materials and Methods

A standardized die was made in die stone of an upper right molar prepared for a full crown. The die was digitalized by an Identica Blue Light Scanner, and the coping substructure was designed using CAD software. Ten milled specimens and ten laser-sintered specimens were manufactured by Renishaw plc based on the generated file by the software. All twenty copings were digitized by the Identica scanner, and the data were superimposed with the original premanufacturing data file of the prepared full crown. Using the Geometric Modelling Library (GML) package, the fit discrepancies were displayed as colour maps showing discrepancies in three dimensions. Each map was made up of thousands of data points carrying numerical error values allowing detailed analyses.

Results

The milled group displayed a mean of fit discrepancies of 42.20 μm (SD 3.04 μm), while the laser-sintered group showed a mean of 42.24 μm fit discrepancies (SD 2.94 μm). Thus, a small difference of 0.04 μm between the two groups was detected.

Conclusions

The evaluated manufacturing systems can be used in dental practice as a small and insignificant discrepancy of fit between the two manufacturing methods was detected.

Accuracy of marginal fit and axial wall contour for lithium disilicate crowns fabricated using three digital workflows

STATEMENT OF PROBLEM

Comparative assessment of the effectiveness of computer-aided design and computer-aided manufacturing (CAD-CAM) technologies used to fabricate complete-coverage restorations is needed. A quantitative assessment requires precise documentation of the marginal adaptation and external surface contour of fabricated restorations. Limited information is currently available regarding the effects of milling mode on marginal adaptation and reproduction of the external surface contour for CAD-CAM-fabricated restorations.

PURPOSE

The purpose of this in vitro study was to evaluate the outcomes for 3 different digital workflows on the marginal gap and the external surface contour reproducibility of CAD-CAM-fabricated lithium disilicate complete-coverage restorations.

MATERIAL AND METHODS

Twelve Ivorine molars were prepared to receive lithium disilicate crowns. The preparations were digitally recorded using 2 intraoral scanners (TRIOS 3; 3Shape A/S and Planmeca PlanScan; E4D Technologies), and the restorations were designed using their associated design software with reference to the anatomy of an unprepared tooth. The designed restorations were then manufactured from lithium disilicate blocks using a 3-axis milling machine. Twelve restorations were manufactured using the detailed mode (Planmeca PlanScan detailed mode [PPD-D]), and 12 using the standard mode for the Planmeca system (Planmeca PlanScan standard mode [PPD-S]). Restorations from the 3Shape system were fabricated using the detailed mode (TRIOS 3Shape detailed mode [T3S-D]). The restorations were secured on their associated preparation with an elastomeric material. The marginal gap of each restoration was then measured in the ImageJ software using images captured by a stereo microscope at ×20 magnification. External surface reproducibility was evaluated by measuring undercut at 4-line angles using a dental surveyor. Differences in the marginal gaps of restorations fabricated using the 3 different workflows were compared by Brown-Forsythe robust ANOVA, followed by a post hoc test (α=.05). Chi-square analysis (α=.05) was used to evaluate differences in the contours of the external surface of the restorations, resistance form, and marginal integrity produced using the 3 workflows.

RESULTS

The mean marginal gap for restorations fabricated using the T3S-D workflow was 60 μm, a distance significantly lower (P<.05) than that of PPD-D and PPD-S workflows, which yielded a marginal gap of 95 μm for the detailed mode and 124 μm for the standard mode of milling. Restorations fabricated using PPD-D and PPD-S workflows produced a significantly more reproducible external surface contour than those fabricated using the T3S-D workflow.

CONCLUSIONS

Restorations fabricated using the T3S-D workflow produced the smallest marginal gap. However, reproducibility of the external surface contour for this workflow was the worst of the three workflows analyzed.

Finish-line designs for ceramic crowns: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Different finish-line designs have been advocated for tooth preparations of ceramic crowns. However, scientific evidence is lacking to help clinicians make a proper selection.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effects of finish-line designs on the marginal and internal adaptations of ceramic crowns.

MATERIAL AND METHODS

This report follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature search was conducted in MEDLINE via the PubMed, Embase, and Web of Science databases with no publication year or language limits. In vitro studies comparing the marginal and internal adaptations of ceramic crowns with rounded shoulder and chamfer finish lines were included in the meta-analysis.

RESULTS

Sixteen studies were included in the qualitative synthesis and meta-analyses. Statistical analyses were conducted using the Review Manager Software. Meta-analyses were performed with random-effects models (α=.05). Ceramic crowns with rounded shoulders exhibited significantly better marginal adaptation than those with chamfers (P<.001; mean difference=-7.8; 95% confidence interval=-11.6 to -4.1). Moreover, ceramic crowns with chamfers exhibited significantly better internal adaptation than those with rounded shoulders (P=.020; mean difference=35.0; 95% confidence interval=6.5 to 63.5).

CONCLUSIONS

The difference in marginal adaptation of ceramic crowns using 2 finish-line designs was small, and the clinical significance was low, whereas the results of internal adaptation favored the chamfer finish line.

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

STATEMENT OF PROBLEM

The marginal and internal adaptations of porcelain laminate veneers (PLVs) are key elements in their long-term success. However, the marginal and internal fit obtained with a pressable material compared with computer-aided design and computer-aided manufacturing (CAD-CAM) needs further investigation as does the choice of cement used.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal and internal fit of PLVs fabricated using pressing and CAD-CAM milling and cemented using 2 types of composite resin cement.

MATERIAL AND METHODS

Twenty PLVs were fabricated from VITA PM9 pressable material, and 20 veneers were milled using VITA Blocs Mark II. Veneers were cemented to composite resin dies using either RelyX Veneer cement or Variolink-N cement. Specimens were embedded in clear resin and sectioned incisogingivally and mesiodistally. Marginal discrepancy at the incisal and cervical positions and the internal gap at 6 different locations were evaluated by using a scanning electron microscope. Two-way ANOVA followed by Tukey multiple comparisons were used to examine difference among groups (α=.05).

RESULTS

The cement and fabrication methods did not show any significant effect for absolute marginal gap (AMG) at the incisal edge, AMG at the cervical margin or marginal gap at the incisal edge. However, both had a significant effect on marginal gap at the cervical margin (P=.038 for the fabrication method and P=.050 for the cement used). Also, both cement and fabrication methods had a significant effect on internal gap average (P<.001). The lowest gap values were reported for veneers fabricated from VITA PM9 by using the press technique and cemented with RelyX Veneer cement. When the position of gap measurements was taken into consideration, it was the only significant factor (P<.001 for the effect of position on AMG and P<.001 for the effect of position on marginal gap). Gaps at the cervical position were significantly lower than gaps at the incisal position.

CONCLUSIONS

Smaller marginal and internal discrepancies were recorded for PLVs fabricated by using the pressing technique and cemented using RelyX Veneer cement compared with milled veneers and Variolink-N cement. Larger discrepancies were present incisally than cervically.

Fracture resistance of all-ceramic crowns based on different preparation designs for restoring endodontically treated molars

OBJECTIVES

To evaluate endodontically treated molar fracture resistance restored with CAD/CAM lithium disilicate (LDS) crowns with different amalgam core preparation design.

MATERIALS AND METHODS

Eighty-four recently extracted mandibular third molars were divided into seven groups (n = 12) and embedded in autopolymerizing resin. Coronal tooth structure was removed, pulp chamber exposed, and pulpal remnants removed. One group received LDS endocrowns, while three groups received amalgam cores with 2, 1, and 0 dentin axial wall heights (AWH). Three additional groups were likewise restored using an amalgam adhesive. Scanned preparations were restored with LDS crowns luted with a self-adhesive luting cement. After 24 hours, specimens were loaded to failure with results analyzed with Welch's Test/REGW Range Test at a 95% level of confidence (α = 0.05).

RESULTS

The 1 mm-AWH amalgam core group had the highest failure load and was similar to the 2 mm-AWH amalgam, 2 mm-AWH bonded amalgam, and the 1 mm-AWH bonded amalgam core groups. The endocrowns had lower failure load than the 1 mm and 2 mm AWH amalgam groups but was similar to other groups.

CONCLUSIONS

Adhesively luted LDS crowns with amalgam core preparations overall displayed similar failure load, as endocrown restorations. However, crowns based on amalgam cores demonstrated favorable failure modes.

CLINICAL SIGNIFICANCE

The results of this in vitro test suggests that when suitable tooth structure and sufficient interact restorative space exists, endodontically treated molars restored with lithium disilicate complete crowns based on preparations with amalgam core foundations containing 1 mm and 2 mm of dentin axial wall height could serve as a suitable restorative option that may provide more recoverable failure modes than endocrown restorations.