An In Vitro Evaluation of Fit of Zirconium-Oxide-Based Ceramic Four-Unit Fixed Partial Dentures, Generated with Three Different CAD/CAM Systems, before and after Porcelain Firing Cycles and after Glaze Cycles

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

Background/purpose

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

Materials and methods

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

Results

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

Conclusion

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

Evaluation of the Marginal Fit of Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) Zirconia Bridges Fabricated With Different Firing Cycles of Veneering Porcelain: An In Vitro Study

Introduction Zirconia provides adequate mechanical strength to be used as a framework for all ceramic prostheses. Such prostheses must be covered with suitable porcelain to obtain good aesthetic results. The aim To study the effect of the firing cycle numbers of veneering ceramics (one cycle, two cycles, and three cycles) on the marginal fit of computer-aided design (CAD) and computer-aided manufacturing (CAM) zirconia bridges. Materials and methods The sample consisted of 30 full ceramic zirconia bridges, designed by CAD/CAM on a metal bridge model that was designed for this purpose. The sample was divided into three groups (N = 10); group A underwent a single firing cycle, group B underwent two cycles, and group C underwent three cycles. The copper model of the bridge was prepared to be a three-unit bridge, and the impressions of the metal models were taken to make zirconia cores. After that, the veneering ceramic layer and the micro-marginal gap were measured (in microns) on both the buccal and lingual surfaces of each bridge in the sample using the replica technique. A one-way ANOVA test was used to detect statistically significant differences between the groups. Results There were no significant differences between the studied groups in binary comparison; however, the arithmetic mean values of the marginal gap in group C were greater than all the studied groups. Conclusion Within the limitations of the current work, we found that increasing the number of firing cycles of zirconia cores affects the marginal fit; thus, it is recommended to follow the two firing cycle protocol for better adaptation of the CAD/CAM zirconia bridges.

Full-Mouth Rehabilitation of a Patient with Gummy Smile-Multidisciplinary Approach: Case Report

The impairment of aesthetic function leads to a decreased quality of life. An unaesthetic smile due to excessive gingival exposure demands, most of the time, a complex treatment in which the objective is the vertical reduction of the amount of exposed fixed gingiva by obtaining a complete exposure of the anatomical crown of the teeth and restoring the ideal dimensions of the biological width. This paper presents a case of a 48-year-old female patient who was unsatisfied with her aesthetics and had disturbed masticatory function due to the absence of some posterior teeth. The cone beam computed tomography was performed to evaluate the facial and dental morphology. The treatment plan included diode laser and piezo-surgery utilization for the frontal area of the upper arch and implants to restore the distal area of the lower and upper arch. Zirconia ceramic was used for the final restorations. This complex and multidisciplinary full-mouth rehabilitation lasted for two years, and the patient was pleased with the result. This case showed that a well-established treatment plan is necessary to obtain long-lasting results. The use of adequate procedures and equipment ensures a predictable result.

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

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of firing procedures and layering thickness of porcelain on internal adaptation of zirconia cantilever resin-bonded fixed dental prostheses

PURPOSE

This study evaluated the influence of firing procedures and layering thickness of porcelain on internal adaptation of maxillary anterior cantilever zirconia resin-bonded fixed dental prostheses (RBFDPs).

METHODS

The maxillary right central incisor on a model was prepared for a single-retainer zirconia RBFDP. A total of 36 frameworks of cantilever zirconia RBFDPs were classified into three groups (CB0.5, CB1.0, and CB2.0 groups) based on the thickness of the cut-back on the facial surface (0.5 mm, 1.0 mm, and 2.0 mm, respectively). Feldspathic porcelain was layered onto the facial surface of the zirconia RBFDP frameworks. Internal space widths between the abutment tooth and the framework were measured before and after porcelain firing by a replica technique. The internal space values before and after porcelain firings were compared using the paired t-test within the same group (α = 0.05). Differences in internal space values (distortion) between before and after porcelain firing were compared using one-way analysis of varianc e and Tukey multiple comparison tests.

RESULTS

For all framework designs, internal space values after porcelain firing were significantly higher than those before firing. Among all groups, the CB0.5 group showed the lowest internal distortion values for the whole measured area. The CB2.0 group showed higher distortion values than the CB1.0 group.

CONCLUSIONS

Porcelain firing procedures negatively impacted the internal space in cantilever zirconia RBFDPs. In addition, the increased volume of layering porcelain had a negative effect on the internal distortion of ma xillary anterior cantilever zirconia RBFDPs.

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.

Effects of porcelain veneering methods on conformity of the marginal and internal fit of three-unit zirconia framework

The purpose of this study is to investigate the effects of porcelain veneering methods on the marginal and internal fit of a three-unit zirconia framework. A zirconia master model, in which the lower-left second premolar and the second left molar were used as the abutment, was obtained using an intraoral scanner. Based on the data, three-unit zirconia frameworks for fabricating all-ceramic bridges were designed and milled (FW group). Two types of all-ceramic bridge were fabricated by veneering porcelain onto these frameworks using the press-over technique (P group) and the layering technique (L group). The replica technique was used to measure the gap size between the abutments and the bridges. Measurements were taken in the marginal opening area (MO), chamfer area (CH), axial area (AX), and occlusal area (OC). Statistical analysis was performed using the Mann-Whitney U-test. There was no significant difference in MO and CH between the P and L groups. However, in AX, the L group had a significantly larger gap size than that of the P group (p = 0.003). In addition, compared with the FW group, the P group showed a significantly larger gap size in MO (p < 0.000), CH (p = 0.008), and OC (p < 0.000). These results indicate that the gap size increased after porcelain veneering using the press-over and layering techniques. In addition, the all-ceramic bridges fabricated using the press-over and layering techniques had approximately equal gap sizes in MO.

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

Objectives:

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

Materials and Methods:

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

Results:

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

Conclusion:

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

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

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Evaluation of marginal adaptation of Co-Cr-Mo metal crowns fabricated by traditional method and computer-aided technologies

Background/purpose

The purpose of this study was to evaluate the marginal gaps of dental restorations manufactured using conventional loss wax and casting, computer-aided design/computer-aided manufacturing (CAD/CAM), and 3D printing methods.

Materials and methods

A zirconia master die model with an upper right first molar resin crown was prepared as a standardized model. A total of 30 resin master die models were duplicated from this standard model. Simultaneously, 10 Co—Cr—Mo metal crowns were individually obtained using the conventional loss wax and casting method (Group A), selective laser sintering (Group B), and CAD/CAM (Group C), respectively. The marginal gaps between the crowns fabricated conventional and digital methods with master die models were calculated using a 3D replica and mapping technique.

Results

Statistical analyses revealed there were significant differences in the marginal gaps in the group A with group B and C (p < 0.05). The mean marginal gaps between dental crowns with die models were 76 ± 61 μm, 116 ± 92 μm, and 121 ± 98 μm for groups A, B, and C, respectively.

Conclusion

Within the limitations of this study, the marginal gaps were clinical acceptable in conventional and digital techniques.

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

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Evaluation of dimensional accuracy of dental bridges manufactured with conventional casting technique and CAD/CAM system with Ceramill Sintron blocks using CMM

Background. Recently, non-presintered chromium-cobalt (Cr-Co) blocks with the commercial name of Ceramill Sintron were introduced to the market. However, comprehensive studies on the dimensional accuracy and fit of multi-unit frameworks made of these blocks using the coordinate measuring machine (CMM) are lacking. This study aimed to assess and compare the dimensional changes and fit of conventional casting and milled frameworks using Ceramill Sintron.

Methods. A metal model was designed and scanned and 5-unit frameworks were fabricated using two techniques: (I) the conventional casting method (n=20): the wax model was designed, milled in the CAD/CAM machine, flasked and invested; (II) the milling method using Ceramill Sintron blocks (n=20): the wax patterns of group 1 were used; Ceramill Sintron blocks were milled and sintered. Measurements were made on the original reference model and the fabricated frameworks using the CMM in all the three spatial dimensions, and dimensional changes were recorded in a checklist. Data were analyzed with descriptive statistics, and the two groups were compared using one-way ANOVA and Tukey test (α=0.05).

Results. The fabricated frameworks in both groups showed significant dimensional changes in all the three dimensions. Comparison of dimensional changes between the two groups revealed no significant differences (P>0.05) except for transverse changes (arch) that were significantly greater in Ceramill Sintron frameworks (P<0.05).

Conclusion. The two manufacturing processes were the same regarding dimensional changes and the magnitude of marginal gaps and both processes resulted in significant dimensional changes in frameworks. Ceramill Sintron frameworks showed significantly greater transverse changes than the conventional frameworks.

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.

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

Purpose

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

Material and Methods

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

Results

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

Conclusion

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

Influence of Material Selection on the Marginal Accuracy of CAD/CAM-Fabricated Metal- and All-Ceramic Single Crown Copings

This study evaluated the marginal accuracy of CAD/CAM-fabricated crown copings from four different materials within the same processing route. Twenty stone replicas of a metallic master die (prepared upper premolar) were scanned and divided into two groups. Group 1 (n = 10) was used for a pilot test to determine the design parameters for best marginal accuracy. Group 2 (n = 10) was used to fabricate 10 specimens from the following materials with one identical CAD/CAM system (GAMMA 202, Wissner GmbH, Goettingen, Germany): A = commercially pure (cp) titanium, B = cobalt-chromium alloy, C = yttria-stabilized zirconia (YSZ), and D = leucite-reinforced glass-ceramics. Copings from group 2 were evaluated for the mean marginal gap size (MeanMG) and average maximum marginal gap size (AMaxMG) with a light microscope in the “as-machined” state. The effect of the material on the marginal accuracy was analyzed by multiple pairwise comparisons (Mann–Whitney, U-test, α = 0.05, adjusted by Bonferroni-Holmes method). MeanMG values were as follows: A: 46.92 ± 23.12 μm, B: 48.37 ± 29.72 μm, C: 68.25 ± 28.54 μm, and D: 58.73 ± 21.15 μm. The differences in the MeanMG values proved to be significant for groups A/C (p = 0.0024), A/D (p = 0.008), and B/C (p = 0.0332). AMaxMG values (A: 91.54 ± 23.39 μm, B: 96.86 ± 24.19 μm, C: 120.66 ± 32.75 μm, and D: 100.22 ± 10.83 μm) revealed no significant differences. The material had a significant impact on the marginal accuracy of CAD/CAM-fabricated copings.

Effect of number of pontics and impression technique on the accuracy of four-unit monolithic zirconia fixed dental prostheses

STATEMENT OF PROBLEM

Because of their relatively small scanning area, intraoral scanners may result in less accurate fixed dental prostheses (FDPs) than do laboratory scanners.

PURPOSE

The purpose of this in vitro study was to evaluate the accuracy of monolithic zirconia FDPs with different numbers of pontics fabricated with different impression techniques.

MATERIAL AND METHODS

The mandibular right premolars and molars of an acrylic resin model were prepared to receive 4-unit FDPs. Three master models were fabricated with epoxy resin: model NP, no pontic; model 1P, 1 pontic; and model 2P, 2 pontics. Each master model was scanned by using direct (DD) and indirect digitalization (ID). Four-unit monolithic zirconia FDPs were fabricated and divided into 3 groups (groups NP, 1P, and 2P) and then subdivided according to the digitalization technique (group DD and ID; n=10). The FDPs were also evaluated based on the presence (Po) or absence (NPo) of an adjacent pontic. The marginal, axial, and occlusal gap widths of each FDP were measured, and statistical analyses were performed to evaluate and compare the amount of gap present (α=.05).

RESULTS

For direct digitalization, group 2P had significantly greater marginal (69.4 μm versus 60.9 μm or 62.3 μm; P<.001) and axial gap widths (127.1 μm versus 108.9 μm or 110.4 μm; P<.001) than group NP or 1P. Group DD resulted in significantly smaller gaps compared with group ID at marginal (64.8 μm versus 73.6 μm), axial (114.8 μm versus 124.3 μm), and occlusal (172.6 μm versus 184.1 μm) measurement locations (P<.001). Greater marginal and axial gaps were noted in group Po than NPo (P<.001).

CONCLUSIONS

The length of the edentulous area significantly influenced the extent of the marginal and internal gap with the use of direct digitalization. Direct digitalization resulted in significantly smaller gap widths in all measurement areas than indirect digitalization; however, the mean differences were less than 12 μm, which is considered clinically insignificant. The presence of an adjacent pontic had a significant effect on the adjacent marginal and axial gap widths.

Marginal and internal fit of pre-sintered Co-Cr and zirconia 3-unit fixed dental prostheses as measured using microcomputed tomography

STATEMENT OF PROBLEM

Limited information is available on the precision of new metal processing technologies.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal and internal fit of pre-sintered cobalt-chromium (Co-Cr) and zirconia 3-unit fixed dental prostheses using x-ray microcomputed tomography.

MATERIAL AND METHODS

Three-unit fixed dental prostheses were prepared on metal dies (N=12) using a typodont model from the maxillary first premolar to the first molar. A standardized preparation with a 1.2-mm chamfer (360 degrees) and a 2-mm occlusal reduction was prepared on abutment teeth. The dies were scanned and divided into 2 groups to receive the fixed dental prostheses (n=6) made of pre-sintered Co-Cr and pre-sintered zirconia. Each framework was seated on its cast, and marginal and internal discrepancies were measured at 9 points, starting from the most distal point from the pontic for the maxillary first premolar and the first molar (points 1-4, mesial; point 5, occlusal; points 6-9, distal) of each abutment tooth using microcomputed tomography. The data were analyzed using the Levene test, t test, and ANOVA (α=.05).

RESULTS

When overall mean discrepancy values were compared, no significant difference was observed between pre-sintered Co-Cr and pre-sintered zirconia (P=.085). Discrepancy values for points 1, 2, and 3 were significantly different for pre-sintered Co-Cr and pre-sintered zirconia, with the lowest mean values for point 1 and the highest for point 5. On the abutment tooth basis, for the maxillary first premolar and the first molar, a significant difference was found only in points 6 (P<.001) and 8 (P<.003) for both materials. When the discrepancies for the maxillary first premolar were considered for pre-sintered Co-Cr and pre-sintered zirconia, the mean values were significantly different only at points 1 (P<.001), 2 (P=.007), and 3 (P=.003) and were smaller for pre-sintered zirconia. For the tooth the first molar, a significant difference was observed at point 2 (P=.002) and point 3 (P=.008) for both materials, where the mean values were higher for pre-sintered Co-Cr than for pre-sintered zirconia. The pairwise comparison between points showed a significant difference between measurement points within each material (P<.05). The increase in values between points 1 and 5 was evident for both pre-sintered Co-Cr and pre-sintered zirconia materials.

CONCLUSIONS

Three-unit fixed dental prostheses made of pre-sintered Co-Cr or zirconia showed similar marginal and internal discrepancy values, with the highest discrepancy values at the occlusal region in both the first premolar and first molar.

Marginal Fit and Retention Strength of Zirconia Crowns Cemented by Self-adhesive Resin Cements

The absolute marginal gap (AMG) precementation and postcementation and the retention of zirconia crowns cemented to standardized molar preparations (4×10) by self-adhesive resin cements (SARCs) were evaluated. The following SARCs were used: RelyX U-200 (RXU200; 3M ESPE, Seefeld, Germany), SmartCem 2 (SC2; Dentsply, Milford, DE, USA), and G-Cem Automix (GCA; GC, Alsip, IL, USA). The control adhesive resin cement was Panavia 21 (PAN; Kuraray Dental Co Ltd, Osaka, Japan). Twenty measuring locations at a constant interval along the margins were marked, and the AMG was measured by an image analysis system connected to a stereomicroscope (20×). The cemented copings were aged 270 days at 100% humidity and 37°C and then underwent 10,000 thermal cycles, 5°C-55°C. After aging, the crowns were tested for retention, and the debonded surfaces were examined at 3× magnification. The mean marginal gaps precementation and postcementation were 34.8 ± 17.4 μm and 72.1 ± 31 μm, respectively, with no statistically significant differences between the cements. A significant difference ( p≤0.001) in retention between the cements was found. The highest values were obtained for SC2 and GCA (1385 Pa and 1229 Pa, respectively), but these presented no statistically significant differences. The lowest values were found for PAN and RXU200 (738 Pa and 489 Pa, respectively), but these showed no statistically significant differences. The predominant mode of failure in all of the groups was mixed, and no correlations were found between marginal gap and retention.

Comparison of the fit of cast gold crowns fabricated from the digital and the conventional impression techniques

PURPOSE

The purpose of this study was to compare the fit of cast gold crowns fabricated from the conventional and the digital impression technique.

MATERIALS AND METHODS

Artificial tooth in a master model and abutment teeth in ten patients were restored with cast gold crowns fabricated from the digital and the conventional impression technique. The forty silicone replicas were cut in three sections; each section was evaluated in nine points. The measurement was carried out by using a measuring microscope and I-Soultion. Data from the silicone replica were analyzed and all tests were performed with α-level of 0.05.

RESULTS

1. The average gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly. 2. In marginal and internal axial gap of cast gold crowns, no statistical differences were found between the two impression techniques. 3. The internal occlusal gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly.

CONCLUSION

Both prostheses presented clinically acceptable results with comparing the fit. The prostheses fabricated from the digital impression technique showed more gaps, in respect of occlusal surface.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

Veneering increased the marginal gap width of copings.

CLINICAL RELEVANCE

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

In vitro evaluation of marginal discrepancy of monolithic zirconia restorations fabricated with different CAD-CAM systems

STATEMENT OF PROBLEM

Dental laboratories use different computer-aided design and computer-aided manufacturing (CAD-CAM) systems to fabricate fixed prostheses; however, limited evidence is available concerning which system provides the best marginal discrepancy.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal fit of 5 different monolithic zirconia restorations milled with different CAD-CAM systems.

MATERIAL AND METHODS

Thirty monolithic zirconia crowns were fabricated on a custom-designed stainless steel die and were divided into 5 groups according to the type of monolithic zirconia crown and the CAD-CAM system used: group TZ, milled with an MCXL milling machine; group CZ, translucent zirconia milled with a motion milling machine; group ZZ, zirconia milled with a dental milling unit; group PZ, translucent zirconia milled with a zirconia milling unit; and group BZ, solid zirconia milled using an S1 VHF milling machine. The marginal fit was measured with a binocular microscope at an original magnification of ×100. The results were tabulated and statistically analyzed with 1-way ANOVA and post hoc surface range test, and pairwise multiple comparisons were made using Bonferroni correction (α=.05).

RESULTS

The type of CAD-CAM used affected the marginal fit of the monolithic restoration. The mean (±SD) highest marginal discrepancy was recorded in group TZI at 39.3 ±2.3 μm, while the least mean marginal discrepancy was recorded in group IZ (22.8 ±8.9 μm). The Bonferroni post hoc test showed that group TZI was significantly different from all other groups tested (P<.05).

CONCLUSIONS

Within the limitation of this in vitro study, all tested CAD-CAM systems produced monolithic zirconia restorations with clinically acceptable marginal discrepancies; however, the CAD-CAM system with the 5-axis milling unit produced the best marginal fit.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL SIGNIFICANCE

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

Comparison of Conventional Methods and Laser-Assisted Rapid Prototyping for Manufacturing Fixed Dental Prostheses: An In Vitro Study

This study assessed whether there are differences in marginal fit between laser-fusion and conventional techniques to produce fixed dental prostheses (FDPs). A master steel die with 2 abutments was produced to receive a posterior 4-unit FDPs and single copings. These experimental models were divided into three groups (n = 20/group) manufactured: group 1, Ni-Cr alloy, with a lost-wax casting technique; group 2, Co-Cr alloy, with selective laser melting (SLM); and group 3, yttria-tetragonal zirconia polycrystal (Y-TZP), with a milling system. All specimens were cut along the longitudinal axis and their adaptation was measured at the marginal and shoulder areas on the right and left sides of each abutment. Measurements were made using a stereomicroscope (×60 magnification) and a scanning electron microscope (×800 magnification). The data were analyzed using one-way analysis of variance and the Bonferroni post hoc test, with a significance cutoff of 5%. Significant differences (P < 0.05) were observed between group 3 and the other groups. The marginal opening was smallest with Co-Cr alloy substructures, while the shoulder opening was smallest with Ni-Cr alloy substructures. Within the limitations of this study, the marginal fit of an FDP is better with rapid prototyping (RP) via SLM than conventional manufacturing systems.

Effects of Computer-Aided Manufacturing Technology on Precision of Clinical Metal-Free Restorations

PURPOSE

The purpose of this study was to investigate the marginal fit of metal-free crowns made by three different computer-aided design/computer-aided manufacturing (CAD/CAM) systems.

MATERIALS AND METHODS

The maxillary left first premolar of a dentiform was prepared for all-ceramic crown restoration. Thirty all-ceramic premolar crowns were made, ten each manufactured by the Lava system, Cercon, and Cerec. Ten metal ceramic gold (MCG) crowns served as control. The marginal gap of each sample was measured under a stereoscopic microscope at 75x magnification after cementation. One-way ANOVA and the Duncan's post hoc test were used for data analysis at the significance level of 0.05.

RESULTS

The mean (standard deviation) marginal gaps were 70.5 (34.4) μm for the MCG crowns, 87.2 (22.8) μm for Lava, 58.5 (17.6) μm for Cercon, and 72.3 (30.8) μm for Cerec. There were no significant differences in the marginal fit among the groups except that the Cercon crowns had significantly smaller marginal gaps than the Lava crowns (P < 0.001).

CONCLUSIONS

Within the limitation of this study, all the metal-free restorations made by the digital CAD/CAM systems had clinically acceptable marginal accuracy.

The elements of life and medicines

Which elements are essential for human life? Here we make an element-by-element journey through the periodic table and attempt to assess whether elements are essential or not, and if they are, whether there is a relevant code for them in the human genome. There are many difficulties such as the human biochemistry of several so-called essential elements is not well understood, and it is not clear how we should classify elements that are involved in the destruction of invading microorganisms, or elements which are essential for microorganisms with which we live in symbiosis. In general, genes do not code for the elements themselves, but for specific chemical species, i.e. for the element, its oxidation state, type and number of coordinated ligands, and the coordination geometry. Today, the biological periodic table is in a position somewhat similar to Mendeleev's chemical periodic table of 1869: there are gaps and we need to do more research to fill them. The periodic table also offers potential for novel therapeutic and diagnostic agents, based on not only essential elements, but also non-essential elements, and on radionuclides. Although the potential for inorganic chemistry in medicine was realized more than 2000 years ago, this area of research is still in its infancy. Future advances in the design of inorganic drugs require more knowledge of their mechanism of action, including target sites and metabolism. Temporal speciation of elements in their biological environments at the atomic level is a major challenge, for which new methods are urgently needed.

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

Objective:

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

Materials and Methods:

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

Results:

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

Conclusions:

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

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

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Using zirconia-based prosthesis in a complete-mouth reconstruction treatment for worn dentition with the altered vertical dimension of occlusion

This clinical report describes the complete mouth reconstruction of a patient with a worn dentition. Computer-aided design and computer-aided manufacturing processed porcelain fused-to-zirconia prostheses were used to achieve good esthetics, function, and biomechanics.

In Vitro Comparison of Marginal and Internal Fit of Press-on-Metal Ceramic (PoM) Restorations with Zirconium-Supported and Conventional Metal Ceramic Fixed Partial Dentures Before and After Veneering

PURPOSE

To compare marginal and internal fit between 3- and 4-unit press-on-metal (PoM) ceramic, zirconia-supported, and conventional metal ceramic fixed partial dentures (FPDs) before and after veneering.

MATERIALS AND METHODS

Ten pieces for each 3- and 4-unit MC, IPS InLine PoM, and IPS e.max ZirCAD/Zir Press FPDs were produced. Cross-sections from silicone replicas were examined and measured with a light microscope. Occlusal, axial, intermarginal, and marginal mean adaptation scores of cross-sectioned replicas and means of measurements obtained from 4 sites were calculated independently.

RESULTS

Mean values for molars were 78.44 ± 32.01 μm (MC), 89.84 ± 29.20 μm (PoM), and 85.17 ± 28.49 μm (Zir). Premolar values were 76.08 ± 27.92 μm (MC), 89.94 ± 23.49 μm (PoM), and 87.18 ± 28.25 μm (Zir). No difference existed between the means of 3- and 4-unit FPDs except the molar-intermarginal region. The mean value of 4-unit FPDs (93.88 ± 25.41 μm) was less than the 3-unit FPDs (103.68 ± 24.55 μm) at the molar-inter marginal region. A gap increase was observed in all sites except the molar-axio-occlusal region after veneering. According to the mean difference, gap increases at the molar-marginal, molar-intermarginal, and premolar-intermarginal regions were statistically significant. A statistical difference was found at the molar-marginal region for 4-unit MCR (p = 0.041) and 4-unit PoM FPDs (p = 0.042) before and after veneering. Gap increase after veneering of 4-unit metal ceramics at molar-intermarginal, premolar-marginal, and premolar-intermarginal regions (p = 0.020; p = 0.015; p = 0.004) was significant.

CONCLUSION

The gap measurements of the IPS InLine PoM and IPS e.max ZirCAD/Zir Press groups were all clinically acceptable. No studies on marginal and internal fit in the IPS InLine PoM system have been published to date. This study should be supported with future studies. No significant increase was observed after press-veneering the IPS e.max ZirCAD frameworks with an IPS e.max ZirPress material; therefore, we recommend the use of this combination.

In vitro evaluation of marginal and internal adaptation of three-unit fixed dental prostheses produced by stereolithography

The purpose of this study was to investigate, by measuring the gap, the possible clinical use of three-unit fixed dental prostheses (FDPs) manufactured using stereolithography. A total of 20 epoxy models were built with a same case (abutment teeth 14, 16). The 40 specimens were produced using the stereolithography (SLA) and wax-up (LW). The 960 gaps of the 40 specimens produced were measured by a silicone replica. The Wilcoxon rank sum test was then used to compare and analyze the data obtained from the two groups (α=0.05). The total gap, as measured from the SLA and LW groups, was 98.6 and 66.6 µm, respectively. The results indicate that the gap in the SLA group is statistically significantly greater than that in the LW group (p<0.05). Further assessment and improvement of the SLA method for the fabrication of FDPs is evidently still required.

Clinical gap changes after porcelain firing cycles of zirconia fixed dentures

PURPOSE

The aim of this study was to measure the changes on the marginal and internal adaptation of zirconia based anterior fixed partial dentures after the porcelain firing process.

MATERIALS AND METHODS

A total of 34 anterior fixed partial dentures using LAVA CAD/CAM system (3M ESPE, Germany) were applied. Two silicone replicas were obtained: one is obtained before porcelain firing process (initial) and the other is obtained after porcelain firing process (final), followed by the examination under a binocular stereomicroscope. Kruskal Wallis and Wilcoxon Signed Ranks tests were used for the statistical analysis (P<.05).

RESULTS

No statistically significant difference was found between initial and final marginal gap values (P>.05). At the internal gap measurements, final marginal area values (59.54 µm) were significantly lower than the initial marginal area values (68.68 µm)(P<.05). The highest and the lowest internal gap values were observed at the incisal/occlusal area and at the marginal area, respectively. In addition, lower internal gap values were obtained for canines than for central incisors, lateral incisors and premolars at the incisal area (P<.05).

CONCLUSION

The firing cycles did not affect the marginal gap of Lava CAD/CAM system, but it is controversial for the internal gap.

Clinical efficacy of veneered zirconium dioxide-based posterior partial fixed dental prostheses: five-year results

STATEMENT OF PROBLEM

In recent years, zirconium dioxide-based partial fixed dental prostheses (FDP) have been suggested as an alternative treatment to traditional metal ceramic FDPs. However, clinical studies evaluating their longevity and related complications are limited.

PURPOSE

The purpose of this cohort clinical study was to assess the efficacy of zirconium dioxide-based posterior 3-unit FDPs.

MATERIAL AND METHODS

Twenty 3-unit posterior FDPs (Lava) were placed in 16 participants missing a second premolar or a first molar. All participants met specific inclusion and exclusion criteria and provided informed consent. All teeth were prepared in a standardized manner: occlusal reduction of 1.5 to 2 mm; axial reduction of 1 to 1.5 mm; a 1.0 mm 360-degree rounded shoulder placed 0.5 mm subgingivally on the facial aspect and supragingivally on the lingual aspect on sound tooth structure; and rounded internal line angles. Definitive impressions were made with vinyl polysiloxane impression material. Frameworks were fabricated by using computer-aided design and computer-aided manufacturing (CAD/CAM) technology with a uniform retainer thickness of 0.6 mm and a minimal connector surface area of 9 mm(2). Restorations were luted with resin-modified glass ionomer cement (Rely-X Luting). Participants were recalled at 2 weeks, 6 months, and 12 months, and thereafter, annually for up to 60 months. Clinical fracture measurements, marginal discoloration, marginal adaptation, radiographic proximal recurrent caries, and periapical pathoses were assessed over time by using modified Ryge criteria. The probability distributions of these variables were calculated for the baseline data and for the recall data. An analysis of survival was made by using the Kaplan-Meier method.

RESULTS

Eighteen FDPs were clinically evaluated at 5 years and 1 at 48 months. Fifteen were rated Alpha for fracture measurements, and 2 were rated Bravo (minor chipping of veneering porcelain and not requiring restoration replacement). Two were rated Charlie (major chipping of veneering porcelain and requiring restoration replacement). Eighteen FDPs were rated Alpha for marginal integrity, and 1 rated Bravo. All restorations were rated Alpha for marginal discoloration. One participant experienced root fracture after 60 months, while another was treated surgically for a periapical pathosis on an endodontically treated abutment.

CONCLUSIONS

Zirconium dioxide-based posterior 3-unit FDPs performed well after 5 years of service.

Marginal fit of anterior 3-unit fixed partial zirconia restorations using different CAD/CAM systems

PURPOSE

Few studies have investigated the marginal accuracy of 3-unit zirconia fixed partial dentures (FPDs) fabricated by computer-aided design/computer-aided manufacturing (CAD/CAM) system. The purpose of this study was to compare the marginal fit of zirconia FPDs made using two CAD/CAM systems with that of metal-ceramic FPDs.

MATERIALS AND METHODS

Artificial resin maxillary central and lateral incisors were prepared for 3-unit FPDs and fixed in yellow stone. This model was duplicated to epoxy resin die. On the resin die, 15 three-unit FPDs were fabricated per group (45 in total): Group A, zirconia 3-unit FPDs made with the Everest system; Group B, zirconia 3-unit FPDs made with the Lava system; and Group C, metal-ceramic 3-unit FPDs. They were cemented to resin dies with resin cement. After removal of pontic, each retainer was separated and observed under a microscope (Presize 440C). Marginal gaps of experimental groups were analyzed using one-way ANOVA and Duncan test.

RESULTS

Mean marginal gaps of 3-unit FPDs were 60.46 µm for the Everest group, 78.71 µm for the Lava group, and 81.32 µm for the metal-ceramic group. The Everest group demonstrated significantly smaller marginal gap than the Lava and the metal-ceramic groups (P<.05). The marginal gap did not significantly differ between the Lava and the metal-ceramic groups (P>.05).

CONCLUSION

The marginal gaps of anterior 3-unit zirconia FPD differed according to CAD/CAM systems, but still fell within clinically acceptable ranges compared with conventional metal-ceramic restoration.

Evaluation of the marginal and internal gap of metal-ceramic crown fabricated with a selective laser sintering technology: two- and three-dimensional replica techniques

PURPOSE

One of the most important factors in evaluating the quality of fixed dental prostheses (FDPs) is their gap. The purpose of this study was to compare the marginal and internal gap of two different metal-ceramic crowns, casting and selective laser sintering (SLS), before and after porcelain firing. Furthermore, this study evaluated whether metal-ceramic crowns made using the SLS have the same clinical acceptability as crowns made by the traditional casting.

MATERIALS AND METHODS

The 10 study models were produced using stone. The 20 specimens were produced using the casting and the SLS methods; 10 samples were made in each group. After the core gap measurements, 10 metal-ceramic crowns in each group were finished using the conventional technique of firing porcelain. The gap of the metal-ceramic crowns was measured. The marginal and internal gaps were measured by two-dimensional and three-dimensional replica techniques, respectively. The Wilcoxon signed-rank test, the Wilcoxon rank-sum test and nonparametric ANCOVA were used for statistical analysis (α=.05).

RESULTS

In both groups, the gap increased after completion of the metal-ceramic crown compared to the core. In all measured areas, the gap of the metal cores and metal-ceramic crowns produced by the SLS was greater than that of the metal cores and metal-ceramic crowns produced using the casting. Statistically significant differences were found between cast and SLS (metal cores and metal-ceramic crown).

CONCLUSION

Although the gap of the FDPs produced by the SLS was greater than that of the FDPs produced by the conventional casting in all measured areas, none exceeded the clinically acceptable range.

An evaluation of marginal fit of three-unit fixed dental prostheses fabricated by direct metal laser sintering system

OBJECTIVES

This in vitro study aimed to evaluate and compare marginal fit of three-unit fixed dental prostheses (FDPs) fabricated using a newly developed direct metal laser sintering (DMLS) system with that of three-unit FDPs by a conventional lost wax technique (LW) method.

METHODS

Ten cobalt-chromium alloy three-unit FDPs using DMLS system and another ten nickel-chromium alloy FDPs using LW method were fabricated. Marginal fit was examined using a light-body silicone. After setting, the silicon film was cut into four parts and the thickness of silicon layer was measured at 160× magnification using a digital microscope to measure absolute marginal discrepancy (AMD), marginal gap (MG) and internal gap (IG). A repeated measure ANOVA for statistical analysis was performed using the SPSS statistical package version 12.0 (α=0.05).

RESULTS

The mean values of AMD, MG, and IG were significantly larger in the DMLS group than in the LW group (p<0.001). Means of AMD, MG and IG in the first molars were 83.3, 80.0, and 82.0μm in the LW group; and 128.0, 112.0, and 159.5μm in the DMLS group, respectively. No significant difference between measurements for premolars and molars was found (p>0.05).

SIGNIFICANCE

The marginal fit of the DMLS system appeared significantly inferior compared to that of the conventional LW method and slightly larger than the acceptable range. For clinical application further improvement of DMLS system may be required.

Implant-supported fixed dental prostheses with CAD/CAM-fabricated porcelain crown and zirconia-based framework

Recently, fixed dental prostheses (FDPs) with a hybrid structure of CAD/CAM porcelain crowns adhered to a CAD/CAM zirconia framework (PAZ) have been developed. The aim of this report was to describe the clinical application of a newly developed implant-supported FDP fabrication system, which uses PAZ, and to evaluate the outcome after a maximum application period of 36 months. Implants were placed in three patients with edentulous areas in either the maxilla or mandible. After the implant fixtures had successfully integrated with bone, gold-platinum alloy or zirconia custom abutments were first fabricated. Zirconia framework wax-up was performed on the custom abutments, and the CAD/CAM zirconia framework was prepared using the CAD/CAM system. Next, wax-up was performed on working models for porcelain crown fabrication, and CAD/CAM porcelain crowns were fabricated. The CAD/CAM zirconia frameworks and CAD/CAM porcelain crowns were bonded using adhesive resin cement, and the PAZ was cemented. Cementation of the implant superstructure improved the esthetics and masticatory efficiency in all patients. No undesirable outcomes, such as superstructure chipping, stomatognathic dysfunction, or periimplant bone resorption, were observed in any of the patients. PAZ may be a potential solution for ceramic-related clinical problems such as chipping and fracture and associated complicated repair procedures in implant-supported FDPs.