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Silva SEGD, Silva NRD, Santos JVDN, Moreira FGDG, Özcan M, Souza RODAE. Accuracy, adaptation and margin quality of monolithic zirconia crowns fabricated by 3D printing versus subtractive manufacturing technique: A systematic review and meta-analysis of in vitro studies. J Dent 2024:105089. [PMID: 38772449 DOI: 10.1016/j.jdent.2024.105089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/28/2024] [Accepted: 05/18/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to evaluate the accuracy (trueness and precision), marginal and internal adaptation, and margin quality of zirconia crowns made by additive manufacturing compared to subtractive manufacturing technology. METHODS The investigation adhered to the PRISMA-ScR guidelines for systematic reviews and was registered at the Prospero database (n°CRD42023452927). Four electronic databases, including PubMed, Scopus, Embase, and Web of Science and manual search was conducted to find relevant studies published until September 2023. In vitro studies that assessed the trueness and precision, marginal and internal adaptation, and margin quality of printed crowns compared to milled ones were included. Studies on crowns over implants, pontics, temporary restorations, laminates, or exclusively experimental materials were excluded. RESULTS A total of 9 studies were included in the descriptive reporting and 7 for meta-analysis. The global meta-analysis of the trueness (P<0.74,I2=90%) and the margin quality (P<0.61,I2=0%) indicated no significant difference between the root mean square of printed and milled zirconia crowns. The subgroup analysis for the printing system showed a significant effect (P<0.01). The meta-analysis of the crown areas indicated no significant difference in most of the areas, except for the marginal (favoring milled crowns) and axial (favoring printed crowns) areas. For precision and adaptation, both methods showed a clinically acceptable level. CONCLUSIONS Additive manufacturing technology produces crowns with trueness and margin quality comparable to subtractive manufacturing. Both techniques have demonstrated the ability to produce crowns with precision levels, internal discrepancy, and marginal fit within clinically acceptable limits. CLINICAL SIGNIFICANCE s3D printing emerges as a promising and potentially applicable alternative method for manufacturing zirconia crowns, as it shows trueness and margin quality comparable to restorations produced by the subtractive method.
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Affiliation(s)
- Sarah Emille Gomes da Silva
- Federal University of Rio Grande do Norte (UFRN), Department of Dentistry, Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil.
| | - Nathalia Ramos da Silva
- Federal University of Rio Grande do Norte (UFRN), Department of Dentistry, Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil.
| | - João Vitor do Nascimento Santos
- Federal University of Rio Grande do Norte (UFRN), Department of Dentistry, Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil.
| | - Fernanda Gurgel de Gois Moreira
- Federal University of Rio Grande do Norte (UFRN), Department of Dentistry, Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil.
| | - Mutlu Özcan
- University of Zurich, Clinic for Masticatory Disorders and Dental Biomaterials, Center for Dental Medicine, Zentrum für Zahnmedizin, Plattenstrasse, 11, 8032 Zurich, Switzerland.
| | - Rodrigo Othávio de Assunção E Souza
- Federal University of Rio Grande do Norte (UFRN), Department of Dentistry, Av. Salgado Filho, 1787, Lagoa Nova, Natal, RN, CEP 59056-000, Brazil.
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Abd EL-wahab A, Shamaa M, Hafez A, El-Wassefy N, Hammad S. Shear bond strength of orthodontic brackets bonded to a new version of zirconium all ceramic restoration: An in vitro comparative study. Heliyon 2023; 9:e16249. [PMID: 37251835 PMCID: PMC10213195 DOI: 10.1016/j.heliyon.2023.e16249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 04/25/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives Esthetic restorations such as monolithic zirconia crowns are highly requested for adults nowadays. Bonding orthodontic braces on this type of material became a challenge for orthodontists, because of the special surface treatment needed. This study aims to assess the shear bond strength (SBS) of metal, and ceramic brackets bonded on two types of zirconia ceramics, surface roughness (SR) after different surface treatments for their surfaces, and adhesive remnant index (ARI). Materials and methods Brackets' base surface area (BSA) was scanned by an extra-oral scanner, then measured. The doubled labial surface of monolithic zirconia crowns (n = 30) and monolithic high translucent zirconia crowns (n = 30) were prepared and each was divided into three groups (n = 10) depending on surface treatment (hydrofluoric acid etching, no treatment, and rocatec airborne abrasion). Extracted lower central incisors (n = 20) were prepared. Each of them was divided into two subgroups depending on the type of bracket bonded on their surfaces (metal and ceramic). The SR, SBS, and ARI were assessed. Statistical analysis used Tests used are independent-samples t-test, Fisher's exact test, One-Way ANOVA, and Kruskal-Wallis test. Results The highest SBS and SR were observed in Enamel/Metal and Zirconia/Metal/Rocatec subgroups, respectively. Conclusion Adequate bond strength could be obtained with the high translucent zirconia group if bonded with ceramic or metal brackets even if no treatment was used. Clinical significance A proportion of simulation was done like practicing inside the dental clinic to reach the best results regarding the adhesion strength of orthodontic brackets.
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Affiliation(s)
- Assem Abd EL-wahab
- Faculty of Dentistry, Mansoura University, Egypt
- Orthodontic Department, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Mansoura, Egypt
| | - Marwa Shamaa
- Orthodontic Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Ahmed Hafez
- Orthodontic Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Noha El-Wassefy
- Biomaterial Department, Faculty of Dentistry, Mansoura University, Egypt
| | - Shaza Hammad
- Orthodontic Department, Faculty of Dentistry, Mansoura University, Egypt
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Lerner H, Nagy K, Pranno N, Zarone F, Admakin O, Mangano F. Trueness and precision of 3D-printed versus milled monolithic zirconia crowns: An in vitro study. J Dent 2021; 113:103792. [PMID: 34481929 DOI: 10.1016/j.jdent.2021.103792] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare the trueness and precision of 3D-printed versus milled monolithic zirconia crowns (MZCs). METHODS A model of a maxilla with a prepared premolar was scanned with an industrial scanner (ATOSQ®, Gom) and an MZC was designed in computer-assisted-design (CAD) software (DentalCad®, Exocad). From that standard tessellation language (STL) file, 10 MZCs (test) were 3D-printed with a Lithography-based Ceramic Manufacturing (LCM) printer (CerafabS65®, Lithoz) and 10 MZCs (control) were milled using a 5-axis machine (DWX-52D®, DGShape). All MZCs were sintered and scanned with the aforementioned scanner. The surface data of each sample (overall crown, marginal area, occlusal surface) were superimposed to the original CAD file (ControlX®, Geomagic) to evaluate trueness: (90-10)/2, absolute average (ABS AVG) and root mean square (RMS) values were obtained for test and control groups (MathLab®, Mathworks) and used for analysis. Finally, the clinical precision (marginal adaptation, interproximal contacts) of test and control MZCs was investigated on a split-cast model printed (Solflex350®, Voco) from the CAD project, and compared. RESULTS The milled MZCs had a significantly higher trueness than the 3D-printed ones, overall [(90-10)/2 printed 37.8 µm vs milled 21.2 µm; ABS AVG printed 27.2 µm vs milled 15.1 µm; RMS printed 33.2 µm vs milled 20.5 µm; p = 0.000005], at the margins [(90-10)/2 printed 25.6 µm vs milled 12.4 µm; ABS AVG printed 17.8 µm vs milled 9.4 µm; RMS printed 22.8 µm vs milled 15.6 µm; p= 0.000011] and at the occlusal level [(90-10)/2 printed 50.4 µm vs milled 21.9 µm; ABS AVG printed 29.6 µm vs milled 14.7 µm; RMS printed 38.9 µm vs milled 22.5 µm; p = 0.000005]. However, with regard to precision, both test and control groups scored highly, with no significant difference either in the quality of interproximal contact points (p = 0.355) or marginal closure (p = 0.355). CONCLUSIONS Milled MZCs had a statistically higher trueness than 3D-printed ones; all crowns, however, showed high precision, compatible with the clinical use. CLINICAL SIGNIFICANCE Although milled MZCs remain more accurate than 3D-printed ones, the LCM technique seems able to guarantee the production of clinically precise zirconia crowns.
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Affiliation(s)
- Henriette Lerner
- Department of Oral Surgery, University of Szeged, Szeged, Hungary.
| | - Katalin Nagy
- Department of Oral Surgery, University of Szeged, Szeged, Hungary.
| | - Nicola Pranno
- Department of Oral and Maxillofacial Sciences, Sapienza University, Rome, Italy.
| | - Fernando Zarone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy.
| | - Oleg Admakin
- Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
| | - Francesco Mangano
- Department of Pediatric, Preventive Dentistry and Orthodontics, Sechenov First State Medical University, Moscow, Russia.
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Lerner H, Mouhyi J, Admakin O, Mangano F. Artificial intelligence in fixed implant prosthodontics: a retrospective study of 106 implant-supported monolithic zirconia crowns inserted in the posterior jaws of 90 patients. BMC Oral Health 2020; 20:80. [PMID: 32188431 PMCID: PMC7081700 DOI: 10.1186/s12903-020-1062-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/03/2020] [Indexed: 01/04/2023] Open
Abstract
Background Artificial intelligence (AI) is a branch of computer science concerned with building smart software or machines capable of performing tasks that typically require human intelligence. We present a protocol for the use of AI to fabricate implant-supported monolithic zirconia crowns (MZCs) cemented on customized hybrid abutments. Methods The study protocol consisted of: (1) intraoral scan of the implant position; (2) design of the individual abutment and temporary crown using computer-aided design (CAD) software; (3) milling of the zirconia abutment and the temporary polymethyl-methacrylate (PMMA) crown, with extraoral cementation of the zirconia abutment on the relative titanium bonding base, to generate an individual hybrid abutment; (4) clinical application of the hybrid abutment and the temporary PMMA crown; (5) intraoral scan of the hybrid abutment; (6) CAD of the final crown with automated margin line design using AI; (7) milling, sintering and characterisation of the final MZC; and (8) clinical application of the MZC. The outcome variables were mathematical (quality of the fabrication of the individual zirconia abutment) and clinical, such as (1) quality of the marginal adaptation, (2) of interproximal contact points and (3) of occlusal contacts, (4) chromatic integration, (5) survival and (6) success of MZCs. A careful statistical analysis was performed. Results 90 patients (35 males, 55 females; mean age 53.3 ± 13.7 years) restored with 106 implant-supported MZCs were included in the study. The follow-up varied from 6 months to 3 years. The quality of the fabrication of individual hybrid abutments revealed a mean deviation of 44 μm (± 6.3) between the original CAD design of the zirconia abutment, and the mesh of the zirconia abutment captured intraorally at the end of the provisionalization. At the delivery of the MZCs, the marginal adaptation, quality of interproximal and occlusal contacts, and aesthetic integration were excellent. The three-year cumulative survival and success of the MZCs were 99.0% and 91.3%, respectively. Conclusions AI seems to represent a reliable tool for the restoration of single implants with MZCs cemented on customised hybrid abutments via a full digital workflow. Further studies are needed to confirm these positive results.
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Affiliation(s)
- Henriette Lerner
- Private Practice, Ludwing-Wilhelm Strasse, 17, Baden-Baden, Germany. .,Lecturer, Academic Teaching and Research Institution of Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
| | - Jaafar Mouhyi
- Casablanca Oral Rehabilitation Training & Education Center (CORTEC), Casablanca, Morocco.,Biomaterials Research Department, International University of Agadir (Universiapolis), Agadir, Morocco
| | - Oleg Admakin
- Department of Prevention and Communal Dentistry, Sechenov First Moscow State Medical University, 119992, Moscow, Russia
| | - Francesco Mangano
- Lecturer, Department of Prevention and Communal Dentistry, Sechenov First Moscow State Medical University, Moscow, Russia
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Nakamura K, Ankyu S, Nilsson F, Kanno T, Niwano Y, Vult von Steyern P, Örtengren U. Critical considerations on load-to-failure test for monolithic zirconia molar crowns. J Mech Behav Biomed Mater 2018; 87:180-189. [PMID: 30077077 DOI: 10.1016/j.jmbbm.2018.07.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 11/30/2022]
Abstract
Application of monolithic zirconia crowns (MZCs) with reduced thickness to the molar region has been proposed, but potential complications have yet to be fully evaluated in laboratory tests. The present study aimed to develop a clinically relevant load-to-failure test in combination with fatigue treatments involving thermal and mechanical cycling (TC and MC) to evaluate the fracture resistance of molar MZCs. MZCs with a minimal thickness of 0.5 mm were bonded to dies made of resin-based composite (RBC), epoxy resin (EP), or polyoxymethylene-copolymer (POM-C). The samples were either untreated (UT) or subjected to TC (5-55 °C for 1 × 105 cycles) and MC (300 N for 2.4 × 106 cycles). The stress generated by TC and MC was simulated by finite element modeling. The load-to-failure test was performed using an inverse V-shaped two-plane indenter and was followed by fractographic analysis. The median values of fracture load for MZC/RBC and MZC/EP in the TC group were significantly lower than those in the UT group. MC also decreased the median value of fracture load for MZC/RBC significantly, but not that for MZC/EP and MZC/POM-C. Fractography revealed that the fracture started in the cervical area in all groups, which is similar to clinically failed crowns. The simulation confirmed stress concentration at the cervical area in both TC and MC groups. The present study suggests that the load-to-failure test using a two-plane indenter could induce clinically relevant fracture of MZCs, the vulnerability of the MZCs depends largely on the die material employed, and MZCs are more likely to be damaged by thermal fatigue than mechanical fatigue.
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Affiliation(s)
- Keisuke Nakamura
- Department of Advanced Free Radical Science, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980 8575, Japan.
| | - Shuhei Ankyu
- Sweden Dental Sendai (private practice), 1-6-2 Tsutsujigaoka, Miyagino-ku, Sendai 983 0852, Japan
| | - Fritjof Nilsson
- Division of Polymeric Materials, Department of Fibre and Polymer Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, SE-100 44 Stockholm, Sweden
| | - Taro Kanno
- Department of Advanced Free Radical Science, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980 8575, Japan
| | - Yoshimi Niwano
- Faculty of Nursing, Shumei University, 1-1 Daigaku-cho, Yachiyo, Chiba 276-0003, Japan
| | - Per Vult von Steyern
- Department of Materials Science and Technology, Faculty of Odontology, Malmö University, SE-205 06 Malmö, Sweden
| | - Ulf Örtengren
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden; Department of Clinical Dentistry/Faculty of Health Sciences, The Arctic University of Norway, Tromsø 9037, Norway
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Nakamura K, Mouhat M, Nergård JM, Lægreid SJ, Kanno T, Milleding P, Örtengren U. Effect of cements on fracture resistance of monolithic zirconia crowns. Acta Biomater Odontol Scand 2016; 2:12-19. [PMID: 27335900 PMCID: PMC4894086 DOI: 10.3109/23337931.2015.1129908] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022]
Abstract
Objectives The present study investigated the effect of cements on fracture resistance of monolithic zirconia crowns in relation to their compressive strength. Materials and methods Four different cements were tested: zinc phosphate cement (ZPC), glass-ionomer cement (GIC), self-adhesive resin-based cement (SRC) and resin-based cement (RC). RC was used in both dual cure mode (RC-D) and chemical cure mode (RC-C). First, the compressive strength of each cement was tested according to a standard (ISO 9917-1:2004). Second, load-to-failure test was performed to analyze the crown fracture resistance. CAD/CAM-produced monolithic zirconia crowns with a minimal thickness of 0.5 mm were prepared and cemented to dies with each cement. The crown–die samples were loaded until fracture. Results The compressive strength of SRC, RC-D and RC-C was significantly higher than those of ZPC and GIC (p < 0.05). However, there was no significant difference in the fracture load of the crown between the groups. Conclusion The values achieved in the load-to-failure test suggest that monolithic zirconia crowns with a minimal thickness of 0.5 mm may have good resistance against fracture regardless of types of cements.
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Affiliation(s)
- Keisuke Nakamura
- Department of Prosthetic Dentistry/Dental Materials Science, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden; Laboratory for Redox Regulation, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Mathieu Mouhat
- Research Group for Biomaterials Used in Dentistry and Medicine, Department for Clinical Dentistry, Faculty of Health Sciences, the Arctic University of Norway , Tromsø , Norway
| | - John Magnus Nergård
- Research Group for Biomaterials Used in Dentistry and Medicine, Department for Clinical Dentistry, Faculty of Health Sciences, the Arctic University of Norway , Tromsø , Norway
| | - Solveig Jenssen Lægreid
- Research Group for Biomaterials Used in Dentistry and Medicine, Department for Clinical Dentistry, Faculty of Health Sciences, the Arctic University of Norway , Tromsø , Norway
| | - Taro Kanno
- Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry , Sendai , Japan
| | - Percy Milleding
- Department of Prosthetic Dentistry/Dental Materials Science, Institute of Odontology, University of Gothenburg , Gothenburg , Sweden
| | - Ulf Örtengren
- Department of Prosthetic Dentistry/Dental Materials Science, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden; Research Group for Biomaterials Used in Dentistry and Medicine, Department for Clinical Dentistry, Faculty of Health Sciences, the Arctic University of Norway, Tromsø, Norway
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