Marginal and Internal Fit of CAD/CAM Crowns Fabricated Over Reverse Tapered Preparations

Influence of apical finish line location of tooth preparations on the scanning accuracy of intraoral scanners with various focal lengths and scanning technologies

STATEMENT OF PROBLEM

Limited studies have reported the influence of finish line location on the accuracy of intraoral scanners (IOSs). Focal length is a hardware characteristic of IOSs. Whether there is a relationship between scanning accuracy of tooth preparations with the finish located at different apical positions and focal length and IOS technology or system remains uncertain.

PURPOSE

The purpose of the present in vitro study was to assess the influence of the apical finish line location of tooth preparations on the accuracy of 4 IOSs with various focal lengths and scanning technologies.

MATERIAL AND METHODS

A maxillary typodont with a crown preparation on the left first molar was digitized (T710). Afterwards, a removable die was created on the prepared first molar of the virtual cast and duplicated to create 4 dies with different apical finish line locations: 2- or 1-mm supragingival, 0-mm or equigingival, and -0.5-mm or intracrevicular. The cast and die designs were additively fabricated (Asiga Pro 4K with Keystone Model Ultra). Each die was independently scanned by using the same laboratory scanner (reference scans). Four groups were created: TRIOS 5, i700, iTero, and Primescan. Four subgroups were developed depending on the apical position of the finish line (n=15). In each subgroup, the cast was assembled by positioning the corresponding die into the cast. The cast was then scanned by using the corresponding IOS. The reference scans were used as a control to compute the root mean square (RMS) error discrepancies with each experimental scan on the preparation and margin of the preparation areas. Two-way ANOVA and pairwise comparisons were used to analyze trueness (α=.05). The Levene and pairwise comparisons using the Wilcoxon Rank sum test were used to analyze precision (α=.05).

RESULTS

Trueness discrepancies in the preparation area were found among the groups (P=.010) and subgroups (P<.001), with a significant interaction between group×subgroup (P<.001). The -0.5 mm location obtained significantly worse trueness in the preparation area. The TRIOS 5 and i700 obtained the best trueness in the preparation area. Trueness discrepancies in the margin area were found among the groups (P=.002) and subgroups (P<.001), with a significant interaction between group×subgroup (P=.004). The -0.5 mm location obtained the worst trueness in the margin area. The i700 and Primescan obtained the best trueness in the margin area. Precision discrepancies were found in the preparation area (P<.001). The TRIOS 5 obtained the best precision in the preparation area (P=.001). Precision discrepancies in the margin area were obtained (P<.001). The 1-mm subgroup obtained the best precision (P=.001).

CONCLUSIONS

The apical position of the finish line of the tooth preparation tested affected the trueness and precision of the IOSs tested.

An in vitro study measuring marginal gaps of inlay restorations fabricated from different CAD-CAM materials after thermocycling

Background

Many monolithic machined materials have been introduced and provided a suitable mechanical and physical properties for inlay restorations. However, there is shortage in the studies evaluating the marginal adaptation using these materials.

Purpose

This study aimed to compare the effect of fabricating inlay restorations from 3 different CAD-CAM materials on marginal gaps before and after thermocycling.

Materials and methods

Sixty human premolars were randomly divided into 3 groups (n = 20) according to the material used: (e.max CAD, Ivoclar AG, Schaan, Liechtenstein), (HC, Shofu, Koyoto, Japan) and (Brilliant Crios, Coltene, Altstätten, Switzerland) (n = 20). A scanning electron microscope (SEM) (JSM- 6510 lv, JEOL, Tokyo, JAPAN) was used to for measuring the marginal gaps after cementation of inlay restorations. The magnification was adapted to 250x. Marginal gaps were revaluated with SEM after thermocycling. The temperatures of baths were 5 and 55 °C was applied for a total of 5000 cycles. All data were statistically analyzed by using ANCOVA to demonstrate if there were any statistically significant differences between the gap measures after thermocycling of the three independent (unrelated) groups. A Bonferroni adjustmen was used to perform post hoc analysis (α = 0.05).

Results

Post-intervention marginal gap was statistically significantly lower in group EX (110.8 μm) which was statistically significant compared with group SF (112.5 μm) (mean difference=-1.768, P = .007) and group BR (113 μm) (mean difference=-2.272, P = .001), however, in. comparing SF and BR groups, there was no significant difference (mean difference=-0.5, P = .770).

Conclusions

Thermocycling affected the marginal gaps of composite based restoration and resin-modified ceramics widely. However, it had a very small effect on glass ceramics marginal adaptation.

Clinical implications

The marginal gaps of CAD-CAM inlays varied according to material used (ceramic based, combination, or resin based). Thermocycling has a minor effect on the marginal adaptation of lithium disilicate glass-ceramic inlays, where it affected the margin of resin-modified ceramic and composite based inlays greatly. Using lithium disilicate glass-ceramic might improve the clinical longevity of inlay restored teeth.

An in vitro study measuring marginal gaps of inlay restorations fabricated from different CAD-CAM materials after thermocycling

BACKGROUND

Many monolithic machined materials have been introduced and provided a suitable mechanical and physical properties for inlay restorations. However, there is shortage in the studies evaluating the marginal adaptation using these materials.

PURPOSE

This study aimed to compare the effect of fabricating inlay restorations from 3 different CAD-CAM materials on marginal gaps before and after thermocycling.

MATERIALS AND METHODS

Sixty human premolars were randomly divided into 3 groups (n = 20) according to the material used: (e.max CAD, Ivoclar AG, Schaan, Liechtenstein), (HC, Shofu, Koyoto, Japan) and (Brilliant Crios, Coltene, Altstätten, Switzerland) (n = 20). A scanning electron microscope (SEM) (JSM- 6510 lv, JEOL, Tokyo, JAPAN) was used to for measuring the marginal gaps after cementation of inlay restorations. The magnification was adapted to 250x. Marginal gaps were revaluated with SEM after thermocycling. The temperatures of baths were 5 and 55 °C was applied for a total of 5000 cycles. All data were statistically analyzed by using ANCOVA to demonstrate if there were any statistically significant differences between the gap measures after thermocycling of the three independent (unrelated) groups. A Bonferroni adjustmen was used to perform post hoc analysis (α = 0.05).

RESULTS

Post-intervention marginal gap was statistically significantly lower in group EX (110.8 μm) which was statistically significant compared with group SF (112.5 μm) (mean difference=-1.768, P = .007) and group BR (113 μm) (mean difference=-2.272, P = .001), however, in. comparing SF and BR groups, there was no significant difference (mean difference=-0.5, P = .770).

CONCLUSIONS

Thermocycling affected the marginal gaps of composite based restoration and resin-modified ceramics widely. However, it had a very small effect on glass ceramics marginal adaptation.

CLINICAL IMPLICATIONS

The marginal gaps of CAD-CAM inlays varied according to material used (ceramic based, combination, or resin based). Thermocycling has a minor effect on the marginal adaptation of lithium disilicate glass-ceramic inlays, where it affected the margin of resin-modified ceramic and composite based inlays greatly. Using lithium disilicate glass-ceramic might improve the clinical longevity of inlay restored teeth.

Comparison of fit and trueness of zirconia crowns fabricated by different combinations of open CAD-CAM systems

PURPOSE

This study aims to clinically compare the fitness and trueness of zirconia crowns fabricated by different combinations of open CAD-CAM systems.

MATERIALS AND METHODS

Total of 40 patients were enrolled in this study, and 9 different zirconia crowns were prepared per patient. Each crown was made through the cross-application of 3 different design software (EZIS VR, 3Shape Dental System, Exocad) with 3 different processing devices (Aegis HM, Trione Z, Motion 2). The marginal gap, absolute marginal discrepancy, internal gap(axial, line angle, occlusal) by a silicone replica technique were measured to compare the fit of the crown. The scanned inner and outer surfaces of the crowns were compared to CAD data using 3D metrology software to evaluate trueness.

RESULTS

There were significant differences in the marginal gap, absolute marginal discrepancy, axial and line angle internal gap among the groups (P < .05) in the comparison of fit. There was no statistically significant difference among the groups in terms of occlusal internal gap. The trueness ranged from 36.19 to 43.78 µm but there was no statistically significant difference within the groups (P > .05).

CONCLUSION

All 9 groups showed clinically acceptable level of marginal gaps ranging from 74.26 to 112.20 µm in terms of fit comparison. In the comparison of trueness, no significant difference within each group was spotted. Within the limitation of this study, open CAD-CAM systems used in this study can be assembled properly to fabricate zirconia crown.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

An in vitro evaluation of marginal fit zirconia crowns fabricated by a CAD-CAM dental laboratory and a milling center

BACKGROUND

Marginal fit is critical for the success and longevity of a dental restoration. Zirconia crowns can be fabricated either chair-side, in a dental laboratory or in a milling center; each can give different marginal fits results. However, discussion of the marginal fit of zirconia crowns when different fabrication methods are compared is lacking in the literature.

PURPOSE

To compare the marginal discrepancy (MD) and absolute marginal discrepancy (AMD) of computer-aided design, and computer-aided manufacturing (CAD-CAM) used in a dental laboratory and a milling center for producing monolithic zirconia crowns.

METHODS

The marginal fit of 30 zirconia crowns cemented to typodont teeth was evaluated by means of a sectioning technique. Fifteen crowns were fabricated with a CEREC inLAB MC X5 from IPS e.max ZirCAD blocks. Fifteen crowns were fabricated using a LAVA milling center from LAVA Plus Zirconia Blocks. The 30 crowns were sectioned with a precision saw, and MD and AMD were subsequently measured using a light microscope. Data were analyzed using the one-way ANOVA technique to investigate significant differences in the marginal fit between the two fabrication systems (α = .05).

RESULTS

The AMD dimension of the CEREC inLAB system was significantly smaller (P < .05). Mean AMD values for zirconia crowns fabricated by the CEREC inLAB were 85 μm, and for the LAVA milling center 133 μm. There was no significant difference between the two systems regarding the MD dimensions. The MD values for zirconia crowns fabricated by the CEREC inLAB were 53 μm and for the LAVA milling center 61 μm.

CONCLUSIONS

The CEREC inLAB system demonstrated significantly better marginal fit in relation to the AMD. However, no difference between the systems was found in the MD. Monolithic zirconia crowns fabricated by the CAD-CAM CEREC inLAB system and the LAVA system milling center showed MD values of less than 120 μm, which is within the clinically acceptable range.

The influence of different cement spaces on the marginal gap of CAD/CAM all-ceramic crowns

BACKGROUND

The purpose of this study was to measure the marginal gaps of CAD/CAM all-ceramic crowns constructed using different cement spaces on crown preparations created by undergraduate students.

METHODS

Twenty-four Columbia model lower left first molars with assessed tapers and reduction volumes (RV) were recruited to receive complete coverage E.max crowns. Three E.max crowns were digitally designed and milled for each crown preparation using three different cement spaces: 50 μm (CS-50), 100 μm (CS-100), 200 μm (CS-200). Each crown was seated onto its original crown preparation and three vertical marginal gap measurements were taken at four locations (mid-buccal, mid-lingual, mid-mesial, mid-distal) using a stereomicroscope. The mean marginal gap (MMG) was calculated for each crown and each individual tooth surface.

RESULTS

The MMG was statistically significantly different for each of the three cement spaces (126 μm for CS-50, 89 μm for CS-100, and 75 μm for CS-200) (P < 0.0001). A taper of between 20 and 30° produced the smallest MMG. Insufficient RV caused significantly larger MMGs. The buccal margin had significantly smaller MMGs than all other measured surfaces.

CONCLUSIONS

The most accurate margins of digitally designed all-ceramic crowns constructed on simulation teeth prepared by undergraduate students were observed when using a 200 μm cement space.