Comparison of Marginal and Internal Adaptation of CAD/CAM and Conventional Cement Retained Implant-Supported Single Crowns

Trueness and adaptation of screw-retained implant-supported monolithic zirconia crowns fabricated using 3-dimensional gel deposition

STATEMENT OF PROBLEM

Implant-supported monolithic zirconia restorations manufactured using the additive 3-dimensional (3D) gel deposition technique have been introduced. However, studies determining the trueness and adaptation of implant-supported crowns made with the technique are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the trueness and adaptation of implant-supported zirconia crowns fabricated using additive 3D gel deposition in comparison with zirconia crowns made with the widely used subtractive milling technique.

MATERIAL AND METHODS

Crowns were fabricated for wide-diameter titanium implants and wide-neck abutments. Self-glazed zirconia (SGZ) crowns were fabricated using 3D gel deposition (n=10) and from 2 brands of zirconia blanks, Wieland and Upcera, using subtractive milling (WMZ and UMZ, n=10). All crowns were digitalized by a scanner, and then 3D deviation analysis was applied. The trueness was assessed by root mean square (RMS). Marginal and internal adaptations were evaluated using the direct-view technique (DT) and replica technique (RT). The results were analyzed by using the 1-way ANOVA and Kruskal-Wallis statistical tests (α=.05).

RESULTS

The RMS and marginal discrepancy of SGZ exhibited the lowest values among the 3 groups (P<.05), and the 2 types of milled zirconia crowns had comparable RMS and marginal discrepancy values (P>.05). The internal discrepancy values of SGZ were significantly lower than those of WMZ and UMZ in all regions (P<.05). Compared with the WMZ, UMZ showed comparable internal discrepancy values in the axial and axio-occlusal transition regions (P>.05) but had significantly lower internal discrepancy value in the occlusal region (P<.05).

CONCLUSIONS

The adaptation of 3 types of wide-diameter implant-supported zirconia crowns can meet the clinical requirements. Compared with the subtractive milling process, 3D gel deposition produced implant-supported zirconia crowns with improved trueness and adaptation.

Internal fit and marginal adaptation of all-ceramic implant-supported hybrid abutment crowns with custom-milled screw-channels on Titanium-base: in-vitro study

BACKGROUND

Advancements in digital dentistry helped in custom-milling screw-channels in implant-supported restorations; however, the fit of these restorations is still unclear especially for contemporary computer aided designing/computer aided manufacturing (CAD/CAM) materials. This study aimed to compare the internal and marginal fit of Ultra translucent multilayered zirconia versus lithium disilicate implant-supported hybrid abutment crowns (HACs) constructed with custom-milled screw-channels on Titanium-base.

MATERIALS AND METHODS

A total of 24 HACs with custom-milled screw-channels were constructed from lithium disilicate (Group LDS) and Ultra translucent multilayered zirconia (Group UT) using digital workflow (n = 12). The internal and marginal gaps of HACs on their corresponding Titanium-bases were assessed using replica technique and stereomicroscope, respectively. After testing for normality, quantitative data were expressed as mean and standard deviation and compared using independent t-test at a level of significance (P ≤ 0.05).

RESULTS

There was no statistically significant difference between Group LDS and Group UT in terms of marginal and internal fit. The internal and marginal gaps in both groups were within the accepted values reported in literature.

CONCLUSIONS

UT and LDS HACs with custom-milled screw-channels demonstrated comparable and acceptable internal fit and marginal adaptations to Ti-base, which lied within the range reported in literature.

The internal and marginal adaptation of lithium disilicate endocrowns fabricated using intra and extraoral scanners: An in-vitro study

OBJECTIVES

The impression technique highly influences the adaptation of ceramic restorations. Not enough information is available to compare the marginal (MF) and internal fit (IF) of endocrowns fabricated with various digitization techniques. Therefore, this in-vitro study aimed to compare the MF and IF of lithium disilicate (LDS) endocrowns fabricated through direct and indirect digital scanning methods.

MATERIALS AND METHODS

One extracted maxillary molar was used to fabricate endocrowns. The digitization of the model was performed with (G1) direct scanning (n = 10) utilizing an intraoral scanner (IOS), (G2) indirectly scanning the conventional impression taken from the model using the same IOS (n = 10), (G3) indirectly digitalizing the obtained impression using an extraoral scanner (EOS) (n = 10), and (G4) scanning the poured cast using the same EOS (n = 10). The MF and IF of the endocrowns were measured using the replica method and a digital stereomicroscope. The Kruskal-Wallis test was used to analyze data.

RESULTS

The studied groups differed significantly (p<0.001). G2 (130.31±7.87 μm) and G3 (48.43±19.14 μm) showed the largest and smallest mean vertical marginal gap, respectively. G2 and G3 led to the highest and lowest internal gaps in all regions, respectively. With significant differences among the internal regions (p<0.001), the pulpal area demonstrated the most considerable misfit in all groups.

CONCLUSIONS

Scanning the impression using an extraoral scanner showed smaller marginal and internal gaps.

Evaluation of the marginal adaptation and debonding strength of two types of CAD-CAM implant-supported cement-retained crowns

BACKGROUND

In-vitro data from a clinically well-known lithium disilicate ceramic reference was used to assess the expected performance of resin-based materials in implant dentistry. The purpose of the study was to compare the bond strength and marginal adaptation of nano-ceramic hybrid composite crowns cemented to stock cement-retained abutments to lithium disilicate crowns.

METHODS

Twenty abutment analogs were embedded into auto-polymerizing acrylic resin blocks. The blocks were divided into 2 groups according to the restorative crown material. The 2 groups were divided as follows: Resin nano-ceramic group and lithium disilicate group. Abutment analogs in both groups were scanned using a laboratory scanner, and the restorations were designed, manufactured, and cemented with resin cement over the corresponding group. All samples were tested for marginal adaptation and bond strength after storage for 24 hours at 37 °C in 100% humidity. Data were collected, tabulated, and statistically analysed using the appropriate tests. Normality was checked using Shapiro Wilk test and Q-Q plots. Data were normally distributed. Variables were presented using mean, 95% Confidence Interval (CI) and standard deviation in addition to median and Inter Quartile Range (IQR). Differences between groups regarding debonding forces was assessed using independent t test. Two Way ANOVA was performed to assess the effect of material and bonding on marginal gap. All tests were two tailed and p value was set at < 0.05.

RESULTS

Marginal gap and debonding force values were significantly different according to the type of material used (P < .05). Resin nano-ceramic crowns presented lower marginal gap values before (20.80 ± 8.87 μm) and after (52.11 ± 22.92 μm) bonding than lithium disilicate crowns. The debonding force value for resin nano-ceramic crowns (284.30 ± 26.44 N) was significantly higher than that for lithium disilicate crowns (253.30 ± 33.26 N). Adhesive failure mode was detected in all the specimens in both groups.

CONCLUSIONS

The type of material used for implant-supported cement-retained crowns had a statistically significant effect on marginal adaptation and bond strength. Resin nano-ceramic implant-supported cement-retained crowns had better marginal adaptation and higher bond strength than those manufactured using lithium disilicate.

Effect of Restoration Design on the Removal Torque Loss of Implant-supported Crowns after Cyclic Loading

AIM

To compare the removal torque loss (RTL) percentage of screw-retained, cement-retained, and combined screw- and cement-retained implant-supported crowns after cyclic loading and measure the impact of cyclic loading on removal torque.

MATERIALS AND METHODS

Thirty-two dental implants (4.0 × 10 mm) in resin blocks and abutments were divided into four groups (n = 8) based on restoration design: combined screw- and cement-retained group (SC), two cement-retained groups: cemented with adhesive resin cement (AR) (Panavia V5) or provisional cement (PR) (RelyX Temp NE), and screw-retained one-piece titanium group (TI). Removal torques were measured in Newton-centimeter (Ncm) before and after 500,000-cycle cyclic loading with forces ranging from 20 to 200 N at 15 Hz. The RTL percentage in each group was calculated. The paired t-test was used to detect the difference between pre-loading (RT1) and post-loading removal torque (RT2) in each group and 1-way ANOVA was used to detect the difference of RTL percentage between groups.

RESULTS

The post-loading removal torques in all groups were significantly lower than their pre-loading removal torques (p < 0.001). The 1-way ANOVA test found no significant difference in the RTL% between the study groups. The PR group exhibited the lower RTL% (30.74 ± 7.3%), followed by the TI (30.78 ± 5.6%), AR (32.12 ± 2.5%), and SC (35.71 ± 5.1%) groups.

CONCLUSION

Combined screw- and cement-retained restorations exhibited similar RTL compared with other restoration designs, and cyclic loading significantly affected the removal torque.

CLINICAL SIGNIFICANCE

Combined screw- and cement-retained restorations can be utilized in single-tooth situations, offering a comparable impact on screw joint stability while providing benefit of retrievability. Cyclic loading significantly influences joint stability, periodic checkup for screw loosening is recommended. How to cite this article: Jongsiri S, Arksornnukit M, Homsiang W, et al. Effect of Restoration Design on the Removal Torque Loss of Implant-supported Crowns after Cyclic Loading. J Contemp Dent Pract 2023;24(12):951-956.

Fit and fatigue behavior of CAD-CAM lithium disilicate crowns

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Evaluation of Internal Adaptation and Marginal Fit of Onlays Fabricated Using Computer-Aided Design (CAD)-Computer-Aided Manufacturing (CAM) and Three-Dimensional Printing Techniques: An In Vitro Study

Background This in-vitro study aimed to evaluate the internal adaptation, marginal fit, and applicability of digital intraoral impression techniques for onlays fabricated using computer-aided design (CAD)-computer-aided manufacturing (CAM) and three-dimensional (3D) printing techniques using a stereomicroscope and micro-CT scan. Methodology A total of 20 extracted mandibular first molars were selected for this study. The teeth were then divided into two groups. Onlay cavities were prepared involving the mesiobuccal cusp of the mandibular first molar in both groups. After preparation, both blocks were sent to the laboratory for fabrication of onlays using digital impressions (Shinning 3D scanner). Once the onlays were fabricated using CAD-CAM and 3D printing, a replica technique with monophase medium body impression material was used to assess the marginal fit and internal adaptation. The accuracy of internal adaptation was evaluated and compared using a stereomicroscope at 20× magnification. Measurements were taken at proximal margins, the inner axial wall, and the occlusal cavosurface area according to the Molin and Karlsson criteria. The same samples of both groups were studied for marginal fit using a micro-CT scan and values were recorded. The data collected were statistically analyzed using an independent Student's t-test. Results Independent Student's t-test results demonstrated that the mean thickness values of the material in the CAD-CAM group at occlusal cavosurface area, proximal area, and axial area were significantly higher when compared to the 3D printing group at p <0.001 and 0.005, respectively. Conclusions Internal adaptation and marginal fit of 3D-printed onlays were significantly lower than CAD-CAM onlays whereas the accuracy of 3D-printed onlays was significantly better than CAD-CAM onlays.

Contemporary Evidence of CAD-CAM in Dentistry: A Systematic Review

In this systematic review, we compare the quality and accuracy of computer-aided design (CAD)/computer-aided manufacturing (CAM) techniques currently employed in dentistry with those of traditional materials. Published literature on the study topic was searched in the online MEDLINE, PsycINFO, PubMed, and Cochrane library databases and the database of Indian Council of Medical Research. For this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was applied for the assessment of studies fit for investigation. Of the total 103 papers searched, 54 underwent in-depth evaluation. Using criteria for what to include and what to leave out, we chose research that was relevant to our review and narrowed it down to 14 papers that met the review's guidelines. According to our findings and the analysis of the chosen articles, the prospects and current advances of CAD/CAM technology are fascinating and are revolutionizing the field of dentistry. Even though researchers are excited, it is important to make sure that different materials have been tested and looked at well enough before making firm claims and choices to replace materials that have been made in the past. Based on previous research, it has been determined that the CAD/CAM methodology used in the dental field is the most popular method at the moment since it is quick, simple, and efficient. Since there are different kinds of CAD/CAM systems, it is very important to choose the right one and come up with a good plan for treating a patient.

Three-dimensional finite element analysis of buccally cantilevered implant-supported prostheses in a severely resorbed mandible

PURPOSE

The aim of the study was to compare the lingualized implant placement creating a buccal cantilever with prosthetic-driven implant placement exhibiting excessive crown-to-implant ratio.

MATERIALS AND METHODS

Based on patient's CT scan data, two finite element models were created. Both models were composed of the severely resorbed posterior mandible with first premolar and second molar and missing second premolar and first molar, a two-unit prosthesis supported by two implants. The differences were in implants position and crown-to-implant ratio; lingualized implants creating lingually overcontoured prosthesis (Model CP2) and prosthetic-driven implants creatingan excessive crown-to-implant ratio (Model PD2). A screw preload of 466.4 N and a buccal occlusal load of 262 N were applied. The contacts between the implant components were set to a frictional contact with a friction coefficient of 0.3. The maximum von Mises stress and strain and maximum equivalent plastic strain were analyzed and compared, as well as volumes of the materials under specified stress and strain ranges.

RESULTS

The results revealed that the highest maximum von Mises stress in each model was 1091 MPa for CP2 and 1085 MPa for PD2. In the cortical bone, CP2 showed a lower peak stress and a similar peak strain. Besides, volume calculation confirmed that CP2 presented lower volumes undergoing stress and strain. The stresses in implant components were slightly lower in value in PD2. However, CP2 exhibited a noticeably higher plastic strain.

CONCLUSION

Prosthetic-driven implant placement might biomechanically be more advantageous than bone quantity-based implant placement that creates a buccal cantilever.

In vitro study of marginal, internal and proximal adaptation of implant-supported single-crown CAD/CAM restorations

Aim: This study evaluated the precision of a CAD/CAM system by measuring marginal, internal and proximal fits in implantsupported single-crown restorations. Methods: Ten models of the upper arch were made in which implants replaced the upper left premolars. For fabrication of the zirconia infrastructures, titanium bases (TiBase) were coded and scanned using a scan body. A second digital impression was made for the fabrication of prostheses. Silicone impression material was used to determine the internal clearance between the TiBase and infrastructure and between the infrastructure and crown, whose thickness was measured at three points [P1 (cervical), P2 (middle) and P3 (occlusal)] with a stereoscopic microscope at 70x and 100x magnification. One-way ANOVA for repeated measures and the Student t-test were used for the analysis of internal and marginal adaptation. Proximal contacts were analyzed qualitatively. Results: There was no significant difference between the teeth evaluated (Student’s t-test; p>0.05) or between the corresponding points evaluated in either tooth (one-way ANOVA; p>0.05). Analysis of the internal clearance between the infrastructure and crown demonstrated that all points were significantly different compared to the reference standardized at 100 μm (Student’s t-test p<0.0001). There was no significant difference between P1 and P2, with the thickness at these two points being lower than that obtained at P3 (one-way ANOVA, p<0.05). The proximal contacts did not coincide with the quality defined by the device. Conclusion: The system tested was unable to produce implantsupported single-crown ceramic restorations with marginal, internal and proximal fits matching the digital workflow, with the inferior fits requiring adjustment prior to cementation.

Five year clinical outcomes of metal ceramic and zirconia-based implant-supported dental prostheses: A retrospective study

OBJECTIVES

The implant-supported restorations can be made of all-ceramic materials. The purpose of this study was to compare five year clinical outcomes of zirconia-based and metal ceramic implant-supported fixed dental prostheses (FDPs).

METHODS

In this study, 114 posterior implant-supported FDPs including zirconia-based (52) or metal ceramic (62) restorations were made for 114 patients with a mean age of 59 ± 8.4 years and evaluated in a 5 year follow up. The modified California Dental Association (CDA) guidelines were used to assess the quality of the restorations. The soft tissue status was evaluated using gingival and plaque indices, probing depth and bleeding on probing. Additionally, the bone loss around implants was assessed by parallel priapical radiographs. The visual analogue scale was used regarding patients' satisfaction. The data analysis were performed by Kaplan-Meier, log rank test, Cox regression, Mann-Whitney U and Student's t-test. (α = 0.05).

RESULTS

Five year Kaplan-Meier survival rate of the zirconia-based and metal ceramic FDPs were 98.1 % and 100 % respectively with no significant difference (P = 0.12). The success rates were 81.6 % for zirconia-based and 81.0 % for metal ceramic restorations (P = 0.85). The CDA rating of both studied groups was not significantly different except the marginal gap which was better in zirconia-based FDPs (P < 0.001). Fracture of veneering ceramics occurred in 2.7 % of metal ceramic and 6.4 % of zirconia-based FDPs, which were not considered as failure. Soft tissue status was not affected by the type of restorations except for plaque index which was more favorable for zirconia-based FDPs (P < 0.001). No significant difference was found between marginal bone loss of the two groups (P = 0.30 mesial, P = 0.46 distal).

CONCLUSIONS

Zirconia-based and metal ceramic FDPs showed similar promising clinical performance in the 5-year follow-up.

CLINICAL SIGNIFICANCE

Zirconia-based implant-supported FDPs might be a successful restorative method with acceptable survival rate and patient's satisfaction.

Ceramic Materials and Technologies Applied to Digital Works in Implant-Supported Restorative Dentistry

Computer-aided design and manufacturing technology has been closely associated with implant-supported restoration. The digital system employed for prosthodontic restorations comprises data acquisition, processing, and manufacturing using subtractive or additive methods. As digital implantology has developed, optical scanning, computer-based digital algorithms, fabricating techniques, and numerical control skills have all rapidly improved in terms of their accuracy, which has resulted in the development of new ceramic materials with advanced esthetics and durability for clinical application. This study reviews the application of digital technology in implant-supported dental restoration and explores two globally utilized ceramic restorative materials: Yttria-stabilized tetragonal zirconia polycrystalline and lithium disilicate glass ceramics.

Marginal Discrepancy of Single Implant-Supported Metal Copings Fabricated by Various CAD/CAM and Conventional Techniques Using Different Materials

Objective  Framework patterns can be formed using various materials such as wax, acrylic resin, or composite. Frameworks can be fabricated using either conventional or computerized techniques, using additive or subtractive method. This study aimed to compare the marginal adaptation of metal copings fabricated by two computerized technologies (milling and rapid prototyping) and additive conventional methods using different materials.

Materials and Methods  Seventy-two fixture analogs were mounted vertically in acrylic resin. One-piece abutments with 5.5 mm in length and 6 degrees of convergence were secured into the analogs. The experimental frameworks were fabricated using either subtractive CAD/CAM milling (by wax, soft or hard metal), additive rapid prototyping (by wax), or conventional pattern fabrication (by wax [control] or acrylic resin). Wax and acrylic resin patterns were casted in Ni-Cr alloy. Marginal discrepancy was measured in 12 points by video measuring machine.

Statistical Analysis  One-way ANOVA and posthoc tests were used to detect any significant difference among the groups at α= 0.05.

Results  There was a statistically significant difference among the marginal discrepancy of six groups ( p = 0.018). The Tukey test indicated a significant difference between CAD/milling of soft metal and conventional wax pattern groups ( p = 0.011); a significant difference was also reported between CAD/milling of wax patterns and control group ( p = 0.046).

Conclusions  Frameworks fabricated by conventional wax-up showed the largest marginal gaps, while the marginal gap created by frameworks made of soft metal CAD/milling were the smallest. In addition, frameworks fabricated by rapid prototyping showed clinically acceptable adaptations.

Effect of different CAD-CAM materials on the marginal and internal adaptation of endocrown restorations: An in vitro study

STATEMENT OF PROBLEM

Recent resin-based and ceramic-based computer-aided design and computer-aided manufacturing (CAD-CAM) materials have been used to restore endodontically treated teeth. Adaptation of the restoration is important for clinical success, but studies evaluating the effect of these materials on the adaptation of endocrowns are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of resin-based and ceramic-based materials on the marginal and internal adaptation of endocrowns.

MATERIAL AND METHODS

Forty mandibular molars were divided into 4 groups (n=10); each group was restored with a different CAD-CAM material: group C: hybrid nanoceramic (Cerasmart; GC Corp), group T: fiber-composite material (Trilor; Bioloren Srl), group E: lithium disilicate glass-ceramic (IPS e.max CAD; Ivoclar Vivadent AG), and group V: zirconia-reinforced lithium silicate glass-ceramic (Vita Suprinity; VITA Zahnfabrik GmbH). A digital scan was made with an intraoral digital scanner (TRIOS 3; 3Shape A/S), and endocrowns were milled with a 5-axis milling machine (Coritec 250i; imes-icore GmbH). The replica technique and a stereomicroscope (×70) were used to measure the marginal and internal adaptation of the endocrowns at 32 points. All data were statistically analyzed using 1-way ANOVA and the Tukey honestly significant difference test (α=.05).

RESULTS

Statistical tests showed significant differences among the tested groups (P<.001). The resin-based groups displayed larger discrepancies than the ceramic-based groups. The resin-based groups showed a mean marginal gap larger than the mean internal gap C (P=.009), T (P<.001), whereas the ceramic-based groups showed similar gaps, V (P=.396), E (P=.936). The largest gap was observed at the pulpal floor (P<.001).

CONCLUSIONS

All materials had clinically acceptable internal and marginal gaps (≤150 μm), except for the marginal gap of the Trilor group.

Fracture behavior, marginal gap width, and marginal quality of vented or pre-cemented CAD/CAM all-ceramic crowns luted on Y-TZP implants

OBJECTIVES

To investigate the fracture behavior and marginal gap region of CAD/CAM fabricated lithium disilicate (L) and zirconium dioxide (Z) crowns using palatal venting (PV), pre-cementation with custom analogs (CA), or conventional cementation technique (SP) with adhesive cement (A) or resin-modified glass ionomer cement (B).

MATERIAL AND METHODS

Twelve groups (n = 6) were set according to material (L, Z), cement (A, B), and technique (PV, CA, SP). Specimens were thermo-mechanical aged (TML), loaded until fracture (LF) and fracture patterns recorded. Marginal gap width and quality were assessed and compared to replicas obtained before and after TML.

RESULTS

Crown material significantly influenced LF with a mean of 1037.6 ± 282.4 N in L and 5356.3 ± 1207.0 N in Z groups (p < .001). Neither cement material nor cementation method affected the outcome. Fractures occurred along the mesial-distal central fissure in both materials. Gap width before TML was 22.04 ± 13.42 μm for L and 19.98 ± 12.72 μm for Z specimens, with overall no influence of crown material, cement type, or method. Marginal cleanliness just below the polished implant shoulder reached 66.7%-88.9% with A, and 91.7%-100% with B, and tended to increase in all groups during TML indicating a decrease in excess cement. Implant-crown junctions were cleaner with B compared to A (p ≤ .001) and along Z crown surfaces compared to L (p ≤ .007).

CONCLUSIONS

Crown venting of lithium disilicate and zirconium dioxide crowns did not affect the fracture load and patterns. Complete cement removal was rare, and the observed particle ablation requires further clinical attention, particularly with submucosal margins.

Accuracy of multi-unit implant impression: traditional techniques versus a digital procedure

OBJECTIVES

The objective of this study was to evaluate the accuracy of different impression techniques on multiple implants.

MATERIAL AND METHODS

A master cast simulating a jaw with four implants was used. Eight impression techniques were tested: open tray-polyether#1, open tray plus splint of impression copings with acrylic resin-polyether#1, closed tray-polyether#1, open tray-polyether#2, open tray-splint-polyether#2, closed tray-polyether#2, open tray-impression plaster, and digital impression (DI). Five impressions of the master cast were taken with each traditional impression (TI) technique, pouring 35 sample casts. Three different clinicians took 5 DI each (n = 15). A three-dimensional coordinate measurement machine (CMM) was used to measure implant angulation and inter-implant distances on TI casts. TI data and DI Standard Tessellation Language datasets were compared with the master cast. The best and the worst impressions made with TI and DI were selected to fabricate four milled titanium frameworks. Passive fit was evaluated through Sheffield test, screwing each framework on the master cast. Gaps between framework-implant analogs were measured through a stereomicroscope (×40 magnification).

RESULTS

Statistically significant differences in accuracy were found comparing the different impression techniques by CMM (p < 0.01). DI performed the best, while TI techniques revealed a greater variability in the results. Sheffield test revealed a mean gap of 0.022 ± 0.023 mm (the best TI), 0.063 ± 0.059 mm (the worst TI), 0.015 ± 0.011 mm (the best DI), and 0.019 ± 0.015 mm (the worst DI).

CONCLUSIONS

Within the limits of this in vitro study, the digital impression showed better accuracy compared to conventional impressioning.

CLINICAL RELEVANCE

The digital impression might offer a viable alternative to traditional impressions for fabrication of full-arch implant-supported prostheses with satisfactory passive fit.