Marginal and internal fit of heat pressed versus CAD/CAM fabricated all-ceramic onlays after exposure to thermo-mechanical fatigue

Comparison of marginal and internal fit of custom-made post and core restorations milled with 4-axis and 5-axis milling machines in Polyetheretherketone and composite

OBJECTIVES

This study aimed to compare the effects of two milling systems (4-axis and 5-axis) and two materials - polyetheretherketone (PEEK) and computer-aided-design/computer-assisted-manufacturing (CAD/CAM) Composite- on the marginal and internal fit of custom-made post and core restorations.

MATERIALS AND METHODS

Eighteen single-rooted premolars were endodontically treated and prepared with a standardized post space of 10 mm. The teeth were scanned to receive post and core restorations, fabricated using the SHERAEco-mill 40 (4-axis) and SHERAEco-mill 50 (5-axis) milling machines (Shera Werkstoff-Technologie, Germany) and two materials-PEEK and Composite. Marginal and internal fit were measured using Geomagic Control X (3D Systems, Rock Hill, SC, USA), based on root mean square (RMS) values obtained from comparing the STL files of the design with the scanned, milled restorations. Data was analyzed with a two-way ANOVA and pairwise t-tests, with Bonferroni correction (p < 0.05).

RESULTS

Pairwise comparisons revealed significant differences in RMS values between milling machines, with 4-axis milled posts showing higher marginal (139.45±24.59 µm) and internal RMS values (135.04±8.68 µm) than 5-axis milled posts (104.14±10.51 µm and 116.22±9.89 µm, respectively). Higher significant RMS values in marginal surfaces were detected (118.60±16.7023.64 µm) for PEEK posts compared to (89.68±4.32 µm) for Composite posts milled with 5-axis. No significant differences were observed between materials for marginal or internal fit in 4-axis and internal fit in 5-axis.

CONCLUSIONS

This in vitro study findings demonstrated a superiority of 5-axis milling machines over 4-axis machines in achieving superior marginal and internal fit for post and core restorations, irrespective of the material utilized. While material selection did not significantly influence fit when employing 4-axis milling, a notable discrepancy emerged with 5-axis milling, where PEEK restorations exhibited poorer marginal fit compared to composite restorations.

CLINICAL SIGNIFICANCE

5-axis milling machines demonstrated superior performance in producing custom-made post and core restorations with enhanced marginal and internal fit compared to 4-axis machines. This improved fit can potentially enhance seating accuracy, minimize cement thickness and micro-gaps, and ultimately contribute to improved long-term clinical outcomes. Furthermore, the lack of significant differences in fit observed between PEEK and CAD/CAM composite materials with 4-axis milling provides clinicians with greater flexibility in material selection based on other clinically relevant factors, such as esthetics, mechanical properties, adhesive properties, and patient preferences.

Effects of preparation design on the marginal and internal fit of CAD-CAM overlay restorations: A µCT evaluation

STATEMENT OF PROBLEM

The effects of different finish line designs on the seating accuracy of partial indirect restorations are unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of different preparation designs on the marginal and internal discrepancy of lithium disilicate computer-aided design and computer-aided manufacture (CAD-CAM) partial indirect restorations before and after thermomechanical aging by using 3-dimensional (3D) microcomputed tomography (μCT).

MATERIAL AND METHODS

Forty human molars were divided according to the preparation design and their location relative to the tooth survey line: SO: rounded shoulder occlusal to the survey line; CO: chamfer occlusal to the survey line; SA: rounded shoulder apical to the survey line; CA: chamfer apical to the survey line (n=10). Ceramic onlays were luted using a universal resin cement (RelyX Universal + Scotchbond Universal Plus). The specimens underwent thermomechanical loading in a mastication simulator (1 200 000 mechanical and 5000 thermal cycles). The marginal and internal discrepancy was evaluated with μCT before and after aging. The volume of cement and internal voids was evaluated with 3-dimensional imaging. The marginal discrepancy (MD), absolute marginal discrepancy (AMD), axial gap (AG), and occlusal gap (OG) were quantified using 2-dimensional analyses. Data were statistically analyzed using a 2-way ANOVA and the Tukey post hoc test (α=.05).

RESULTS

Preparation designs apical to the survey line resulted in a larger volume of cement compared with those occlusal to the survey line (P<.05). No differences were observed in the internal voids among the groups immediately or after aging (P>.05). Both preparation designs and aging had a significant influence on the MD, AMD, AG, and OG (P<.05). Specifically, CB exhibited significantly greater values for AMD, MD, AG, and OG compared with all other preparations (P<.05). CA and SA performed significantly worse than CO and SO in terms of AMD and MD (P<.005).

CONCLUSIONS

Preparations located occlusal to the survey line, particularly CO, demonstrated superior results with respect to both marginal and internal adaptations. CA exhibited the least favorable adaptation among the preparations investigated. Aging had a detrimental impact on the marginal adaptation of the restorations, regardless of the specific preparation design used.

Evaluation of Internal and Marginal Accuracy (Trueness and Precision) of Laminates Using DLP Printing and Milling Methods

This study evaluated the internal and marginal accuracy (trueness and precision) of zirconia laminate veneers fabricated using the DLP printing and milling method, employing 3D analysis software program. The maxillary central incisor tooth of a typodont model was prepared by a dentist and scanned using a desktop scanner. An anatomical zirconia laminate was designed using computer-aided design (CAD) software and saved in a standard tessellation language (STL) format. Thirty zirconia laminates were manufactured using a milling machine (MLL group) and a DLP printer (PTL group). All the specimens were scanned, and their internal and marginal areas were edited accordingly. The root-mean-square value was used to assess the accuracy of the internal and marginal areas of the zirconia laminates. Statistical significance was evaluated using the Mann-Whitney U test. Statistically significant differences were found in RMS values for both groups in the internal and marginal areas (p < 0.001 and p = 0.034, respectively). The MLL and PTL groups differed significantly in terms of precision (p = 0.017), but not at the margin (p = 0.361). DLP-printed zirconia laminates demonstrated stable and consistent performance, making the technique a reliable option for producing esthetic prostheses.

Ketoprofen Associated with Hyaluronic Acid Hydrogel for Temporomandibular Disorder Treatment: An In Vitro Study

Temporomandibular disorders (TMD) are a public health problem that affects around 12% of the global population. The treatment is based on analgesics, non-steroidal anti-inflammatory, corticosteroids, anticonvulsants, or arthrocentesis associated with hyaluronic acid-based viscosupplementation. However, the use of hyaluronic acid alone in viscosupplementation does not seem to be enough to regulate the intra-articular inflammatory process. So, we propose to develop and evaluate the physicochemical and biological properties in vitro of hyaluronic acid hydrogels (HA) associated with ketoprofen (KET) as a new therapeutic treatment for TMD. The hydrogels were synthesized with 3% HA and 0.125, 0.250, 0.500, or 1% KET. Physicochemical analyses of Attenuated Total reflectance-Fourier transform infrared spectroscopy (FTIR), Thermogravimetry (TGA), Rheology by Frequency, Amplitude sweeps, temperature ramp, and scanning electron microscopy (SEM) were performed with or without sterilization and cycled. Cytocompatibility and genotoxicity (micronucleus assay) were performed in mouse macrophages (RAW 264-7) for 24 h. Results: FTIR spectrum showed characteristic absorptions of HA and KET. In the TGA, two mass loss peaks were observed, the first representing the water evaporation at 30 and 100 °C, and the second peaks between 200 and 300 °C, indicating the degradation of HA and KET. Rheology tests in the oscillatory regime classified the hydrogels as non-Newtonian fluids, time-dependent, and thixotropic. Mouse macrophages (RAW 264-7) presented viability of 83.6% for HA, 50.7% for KET, and 92.4%, 66.1%, 65.3%, and 87.7% for hydrogels, in addition to the absence of genotoxicity. Conclusions: Hyaluronic acid associated with ketoprofen shows satisfactory physicochemical and biological properties for use as viscosupplementation. As a limiting point of this study, further research is needed to evaluate the pharmacodynamic, toxicological, and pharmacokinetic characteristics of a complete organism.

Advantages and drawbacks of different methods to measure marginal gaps in fixed dental prostheses: A scoping review

OBJECTIVES

This review aimed to compare traditional and digital methods to assess marginal gaps in fixed dental prostheses. Each method's characteristics, advantages, and limitations were identified and discussed, also addressing the knowledge gaps in the current scientific literature.

DATA

Studies comparing currently available techniques for marginal gap examination were investigated. The main techniques analyzed were the Cross-Sectional Method (CSM), Direct View (DV), Silicone Replica Technique (SRT), Dual-Scan Method (DSM), Triple-Scan Method (TSM), Optical Coherence Tomography (OCT), and Micro-Computed Tomography (MCT).

SOURCES

Two experienced independent reviewers screened online databases (MEDLINE via PubMed and Scopus) to identify studies published in English up to March 2024. References from primary studies and the main peer-reviewed scientific journals were manually searched.

STUDY SELECTION

From an initial pool of 8126 articles, the reviewers meticulously selected 25 in vitro studies on objective comparisons between two or more methods for assessing marginal gaps in fixed dental prostheses on natural teeth. Publications that assessed marginal gaps in implant-supported fixed dental prostheses were excluded.

CONCLUSIONS

This study highlights that while traditional methods like CSM and SRT are widely used and validated, they have limitations in comprehensive gap assessment, often neglecting recommended measurement points. The DV technique, focusing solely on external gaps, may be less relevant for modern assessments. Conversely, three-dimensional techniques like TSM, DSM, OCT, and MCT offer a more thorough evaluation of dental restoration fit. Moreover, digital methods such as TSM and DSM have a significant potential for future clinical application.

CLINICAL SIGNIFICANCE

This review examined methods for evaluating marginal gaps in fixed dental prostheses. The review aids dental professionals and researchers in choosing the most suitable technique for clinical in vivo or laboratory assessment of the marginal adaptation of dental restorations. This study also indicates the need for an established and standardized assessment protocol for the marginal fit.

Long-term Survival Rate and Clinical Quality of Individually Layered Indirect Composite Restorations in Adolescents and Young Adults

PURPOSE

To evaluate the survival and clinical quality of individually layered indirect composite restorations (ICRs) in the mixed and permanent dentition at two study centers.

MATERIALS AND METHODS

A total of 155 adhesively cemented ICRs in 34 participants (aged 6 to 50 years and treated between 2008 and 2018) were evaluated for survival and clinical quality. All were individually layered restorations fabricated from laboratory sculptable composites by a specialized dental technician. Two calibrated independent investigators examined and graded each restoration as success, survival with repair, or failure based on the FDI criteria. The marginal quality and gap width of the restorations were analyzed by scanning electron microscopy. The periodontal health of treated teeth (TT) was evaluated in comparison with that of unrestored control teeth (CT) by measuring the pocket depth (PD), clinical attachment level (CAL), sulcus bleeding index (SBI), and the modified Turesky Plaque Index (TPI). A serial t-test (p 0.05) was used for statistical analysis of periodontal parameters. Success and functional survival rates were calculated using the Kaplan-Meier method.

RESULTS

Molar incisor hypomineralization (MIH) was the most common indication for treatment (41%). The median age at treatment was 14.9 years (68%-CI: 7.7-29.5). The median service time of the restorations was 5.7 ± 3.4 years. 132 restorations were classified as a success, 21 as survival with repair, and 1 as a failure. The success rates at 1, 5, and 10 years were 95.4%, 87.4%, and 78.8%, respectively, and the corresponding functional survival rates were 100.0%, 98.9%, and 98.9%. The clinical quality, encompassing esthetic, functional, and biological criteria, was rated as excellent or good in over 90%. Periodontal response, however, was the only criterion showing worse results since restored teeth (TPI = 1.9) had significantly more plaque than CT (TPI = 1.7; p = 0.0001). No significant differences were observed in PD, CAL, or SBI. The mean marginal gap width was 135.7 µm and 63.8% of the restorations had perfect margins.

CONCLUSION

ICRs are suitable for minimally invasive restoration of large tooth structure defects in the developing dentition of children and adolescents and for long-term temporary restoration of the adult dentition.

Esthetic and Functional Posterior Rehabilitation With Lithium Disilicate Ceramics for the Replacement of Gold Alloy and Metal-Ceramic Restorations: A Clinical Case With a 10-Year Follow-Up

OBJECTIVE

This case report illustrates a clinical scenario of a patient with insufficient crowns, gold onlays and localized tooth pain in the posterior teeth, treated with partial and full coverage lithium disilicate restorations.

CLINICAL CONSIDERATIONS

A female patient presented in the clinics, complaining about tooth pain and unesthetic metal restorations. After a thorough examination, diagnosis and treatment plan, the existing restorations were removed, and a defect-oriented preparation was done to preserve as much as possible of the remaining tooth structure. Final partial and full coverage lithium disilicate restorations were delivered. After a 10-year follow-up no biological complications were observed. Nevertheless, one major chipping was observed in one of the upper molars. This technical complication was resolved with the fabrication of a new ceramic restoration.

CONCLUSION

Lithium disilicate ceramic posterior full- or partial-coverage restorations are a reliable and predictable treatment option not only for the replacement of tooth structure lost due to caries but also for the replacement of insufficient restorations.

CLINICAL SIGNIFICANCE

The following key factors are to be considered to pursue long-term success with ceramic restorations: patient selection, minimal invasive tooth preparation, appropriate material selection and cementation. Nevertheless, complications are to be expected, and the patient should be informed accordingly.

Load-bearing capacity, internal accuracy and time-efficiency of heat-pressed, milled and 3D-printed lithium disilicate ultra-thin occlusal veneers

OBJECTIVES

The primary aim of this in vitro study was to compare the load-bearing capacity of lithium disilicate occlusal veneers, fabricated via different manufacturing processes. Secondary objectives included assessing internal accuracy and production time-efficiency.

METHODS

Four fabrication methods for ultra-thin lithium disilicate occlusal veneers on extracted human molars with simulated erosive defects were compared (n = 20/group): CAM: milled lithium disilicate (IPS e.max CAD); HPR: heat-pressed lithium disilicate (IPS e.max Press) out of a milled PMMA template (Ddpmma CAST); 3DP: 3D-printed lithium disilicate (experimental lithium disilicate); PTE: heat-pressed lithium disilicate (IPS e.max Press) out of a 3D-printed template (SilaPrint cast). Internal accuracy was measured prior to thermo-mechanical aging, followed by static loading to measure the load-bearing capacity (Fmax). Fabrication time (time-efficiency) was also recorded. Statistical analysis was performed using the Kruskal-Wallis (KW) test.

RESULTS

No statistically significant differences were found in median load-bearing capacities (Fmax) between the groups (KW p = 0.5902): CAM 1821 N, HPR 1896 N, 3DP 2003 N, PTE 1687 N. Significant differences were found in internal accuracy between the groups that employed printing processes (3DP, PTE) and all other groups in margins (p < 0.001), cusps (p < 0.0018), and fossae (p < 0.0346). The time-efficiency measurements indicated an increase in fabrication time, starting from CAM 67.2 ± 5.8 min, followed by HPR 200.8 ± 33.0 min, PTE 289.2 ± 38.7 min, and peaking with the highest duration observed for 3DP 701.6 ± 8.1 min.

SIGNIFICANCE

The fabrication method of ultra-thin lithium disilicate occlusal veneers does not significantly impact their load-bearing capacity, but affects the clinical fit and adaptation of the veneers.

Advances in ceramics for tooth repair: From bench to chairside

OBJECTIVES

To give a comprehensive review of advancement in dental ceramics, fabrication methods, and the challenges associated with clinical application.

DATA, SOURCES AND STUDY SELECTION

Researches on chemical composition, biomechanical behaviors, optical properties, bonding strategies and fabrication methods were included. The search of articles was independently conducted by two authors in the PubMed, Scopus, Medline and Web of Science.

CONCLUSIONS

Dental ceramics have shown significant advancements in terms of esthetics and function. However, improving fracture toughness without compromising optical properties remains a challenge. Repairing fractured zirconia or glass-matrix ceramic prostheses with the same material is difficult due to the sintering process. Developing innovative bonding techniques that provide strong and long-lasting bonding strength between ceramics and tooth structures poses a recurring obstacle.

CLINICAL SIGNIFICANCE

Despite the emergence of dental ceramics and fabrication techniques, certain limitations such as susceptibility to brittleness and fracture still exist. Therefore, the current review provided valuable information around the advanced dental ceramics in tooth repair. The laboratory test data and the clinical outcome are also presented in details, aiming to guide clinicians in making informed decisions regarding ceramic restorations.

Impact of different complete coverage onlay preparation designs and the intraoral scanner on the accuracy of digital scans

STATEMENT OF PROBLEM

The trueness and precision of intraoral scanners (IOSs) and the effect of intracoronal restorations have been reported. However, studies addressing the accuracy of IOSs in reproducing different complete coverage onlay preparation designs are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of complete coverage onlay preparation design and intraoral scanning devices on the accuracy of digital scans in terms of trueness and precision.

MATERIAL AND METHODS

Three preparation designs on the mandibular first molar were considered: a traditional preparation design with isthmus reduction (IST), a traditional preparation design without isthmus reduction (wIST), and simplified nonretentive preparation (nRET). Digital scans of epoxy resin mandibular arch reference models of the preparations (containing second premolar, first molar, and second molar) were obtained by using 3 IOSs (iTero Element 2 [ELE], TRIOS 3 [TRI], and Primescan [PRI]) (n=10). Trueness (μm) and precision (μm) were analyzed by superimposing the digital scan on the digital reference models obtained with a high-accuracy industrial scanner (ATOS Core 80) in a tridimensional metrology software program. Accuracy was quantified by the absolute deviation (μm). Local and overall mean positive and negative deviations for trueness were also obtained. Data were analyzed by using the Kruskal-Wallis and Dunn tests with a statistical software program (α=.05).

RESULTS

The nonretentive preparation groups obtained higher trueness (3.8 μm) and precision (2.7 μm) than the IST and wIST groups (trueness=7.5 to 6.3 μm, precision=5.5 to 4.6 μm). Trueness values were lower with ELE×IST (16 μm), followed by ELE×wIST (13 μm), and PRI×IST (7.8 μm). In general, no difference was found between PRI and TRI scanners (6.3 to 5.9 μm), with lower performance for ELE (13 μm). Positive deviations were higher on the proximal box of the IST and wIST preparation and on the occlusal box of the IST group. Negative deviation was higher on the ELE×IST occlusal box.

CONCLUSIONS

Different intraoral scanners and preparation designs influenced the accuracy of digital scans. A more complex preparation such as IST and wIST showed higher deviation. The iTero Element 2 scanner exhibited higher deviation for both trueness and precision.

Trueness, physical properties, and surface characteristics of additive-manufactured zirconia crown

OBJECTIVE

This study aimed to conduct a comparison of trueness and physical and surface properties among five distinct types of additive manufactured (AM) zirconia crowns and zirconia crowns produced using the subtractive manufacturing (SM).

MATERIAL AND METHODS

Zirconia crowns were fabricated using five distinct techniques, each varying in the method of slurry transfer and photocuring source. Each experimental group utilized either one of the four digital light processing (DLP)-based techniques (DLP spreading, DLP spreading gradation, DLP vat and DLP circular spreading) or the stereolithography (SLA)-based technique (SLA spreading). The control (CON) group employed SM. To assess accuracy, trueness was measured between the scan and reference data. To analyze the physical properties, voids were examined using high-energy spiral micro-computed tomography scans, and the crystal structure analysis was performed using X-ray diffraction (XRD). Surface roughness was assessed through laser scanning microscopy.

RESULTS

Differences in the trueness of internal surfaces of crowns were found among the groups (P < 0.05). Trueness varied across the measurement surfaces (occlusal, lateral, and marginal) in all the groups except for the DLP spreading gradation group (P < 0.05). Voids were observed in all AM groups. All groups showed similar XRD patterns. All AM groups showed significantly greater surface roughness compared to the CON group (P < 0.001).

CONCLUSION

The AM zirconia crowns showed bubbles and a rougher surface compared to the SM crowns. All groups exhibited typical zirconia traits and trueness levels within clinically acceptable limits, suggesting that current zirconia AM techniques could be suitable for dental applications.

Accuracy of the intaglio surface of 3D-printed hybrid resin-ceramic crowns, veneers and table-tops: An in vitro study

OBJECTIVES

The present study aims to examine the influence of the build angle on the accuracy (trueness and precision) of 3D printed crowns, table-tops and veneers with a hybrid resin-ceramic material.

METHODS

One crown, on table-top and one veneer were printed in five different build angles (0°, 30°, 45°, 60°, 90°) (n = 50) with the digital light processing (DLP) system (Varseo XS, Bego) using hybrid resin (Varseo Smile Crownplus A3, Bego). All printed restorations were scanned using the laboratory scanner (D2000, 3Shape) and matched onto the initial reference design in metrology software (Geomagic Control X, 3D Systems). The root mean square error (RMSE) was calculated between the scanned and reference data. The data was statistically analyzed using the Tukey multiple comparison test and Wilcoxon multiple comparison test.

RESULTS

The crown group showed higher trueness at 30° (0.021 ± 0.002) and 45° (0.020 ± 0.002), and table-tops at 0° (0.015 ± 0.001) and 30° (0.014 ± 0.001) (p < 0.0001). Veneers demonstrated higher trueness at 30° (0.016 ± 0.002) (p < 0.0001). All three restoration types demonstrated the lowest trueness at a 90° build angle and portrayed deviations along the z axis. The veneer and table-top groups showed the lowest precision at 90° (veneers: 0.021 ± 0.008; table-tops: 0.013 ± 0.003). The crown group portrayed the lowest precision at 45° (0.017 ± 0.005) (p < 0.0001).

CONCLUSION

The build angle of DLP-printed hybrid resin-ceramic restorations influences their accuracy.

CLINICAL SIGNIFICANCE

Considering the build angle is important to achieve a better accuracy of 3D-printed resin-ceramic hybrid restorations. This may help predict or avoid the interference points between a restoration and a die and minimize the clinical adjustments.

Using digital photographs as a tool to assess the clinical color stability of lithium disilicate veneers: A clinical trial

STATEMENT OF PROBLEM

Clinical information regarding the color stability of lithium disilicate veneers by using different methods of evaluation is scarce.

PURPOSE

This clinical trial aimed to evaluate whether digital photographs are a reliable method of clinically assessing the color stability of lithium disilicate veneers. Standardized digital photographs (ELAB) were compared with the VITA Easyshade spectrophotometer (ES) at baseline and at a 6-month follow-up.

MATERIAL AND METHODS

A split-mouth model was used in this randomized clinical trial to assess the performance of ceramic veneers (N=162), which were produced by either the CAD (IPS e.max CAD; n=81) or PRESS technique by heat pressing (IPS e.max PRESS; n=81), including the color dimension assessment. The ELAB evaluation was performed by making digital photographs with polarized light and a white balance (WhiBal) card. These data were transferred to the Adobe Lightroom CC2015 software program in RAW extension. The Digital Color Meter App (Apple) was used to measure L∗, a∗, and b∗ coordinates in this method. The ES color evaluation was performed with a spectrophotometer (Easy Shade) (control group) in the CIELab system. Measurements were performed 1 week after cementation (baseline) and at a 6-month follow-up. Data collected by the ELAB and ES methods were analyzed by a blinded calibrated operator to calculate ΔE by using the Mann-Whitney-Wilcoxon test (α=.05).

RESULTS

For all periods, the comparison among ELAB and ES methods (P=.331), CAD×PRESS by ELAB (P=.658), and CAD×PRESS by ES (P=.833) showed no statistically significant differences.

CONCLUSIONS

Standardized digital photographs (ELAB) were shown to be a straightforward and available resource for evaluating the color stability of lithium disilicate veneers, manufactured by CAD or PRESS.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Clinical comparison of marginal fit of ceramic inlays between digital and conventional impressions

PURPOSE

The aim of this stuldy was to compare the clinical marginal fit of CAD-CAM inlays obtained from intraoral digital impression or addition silicone impression techniques.

MATERIALS AND METHODS

The study included 31 inlays for prosthodontics purposes of 31 patients: 15 based on intraoral digital impressions (DI group); and 16 based on a conventional impression technique (CI group). Inlays included occlusal and a non-occlusal surface. Inlays were milled in ceramic. The inlay-teeth interface was replicated by placing each inlay in its corresponding uncemented clinical preparation and taking interface impressions with silicone material from occlusal and free surfaces. Interface analysis was made using white light confocal microscopy (WLCM) (scanning area: 694 × 510 µm2) from the impression samples. The gap size and the inlay overextension were measured from the microscopy topographies. For analytical purposes (i.e., 95-%-confidence intervals calculations and P-value calculations), the procedure REGRESS in SUDAAN was used to account for clustering (i.e., multiple measurements). For p-value calculation, the log transformation of the dependent variables was used to normalize the distributions.

RESULTS

Marginal fit values for occlusal and free surfaces were affected by the type of impression. There were no differences between surfaces (occlusal vs. free). Gap obtained for DI group was 164 ± 84 µm and that for CI group was 209 ± 104 µm, and there were statistical differences between them (p = .041). Mean overextension values were 60 ± 59 µm for DI group and 67 ± 73 µm for CI group, and there were no differences between then (p = .553).

CONCLUSION

Digital impression achieved inlays with higher clinical marginal fit and performed better than the conventional silicone materials.

Influence of the Crystallization Firing Process on Marginal and Internal Adaptation of Silicate-based Glass-ceramic Inlays Fabricated With a CAD/CAM Chairside System

OBJECTIVE

Computer-aided design/computer-aided manufacturing (CAD/CAM) systems are widely used in dental treatment. Clinicians can use chairside CAD/CAM technology, which has the advantage of being able to fabricate inlays on the same day. We aimed to evaluate the effects of crystallization firing processes, fabrication methods (one-step and two-step), and materials on marginal and internal adaptations of silicate-based glass-ceramic all-ceramic inlays fabricated with CAD/CAM chairside systems.

METHODS

Ten artificial mandibular left first molars were prepared with standardized ceramic class II mesialocclusal (MO) inlay cavities. Optical impressions were obtained using CEREC Omnicam Ban. IPS e-max CAD (IE), (Ivoclar Vivadent, Schaan, Liechtenstein), Initial LiSi Block (LS) (Hongo, Bunkyoku, Tokyo, Japan), VITA Suprinity (SP), (Vita Zahnfabrick, Bad Säckingen, Germany), and Celtra Duo (CD) (Ivoclar Vivadent, Schaan, Liechtenstein) (n=10) were milled using CEREC MC XL (Bensheim, Germany). IE and SP were crystallization-fired using CEREC Speed Fire. The silicone replica technique was used for the measurement of internal (axial and pulpal walls) and marginal (cervical and occlusal edge) adaptations. The adaptations were measured using a thin layer of light-body polyvinyl siloxane impression material placed between the master tooth inlay preparation and restoration. Marginal and internal adaptations of IE, LS, SP, and CD were measured using a stereomicroscope (500×). For IE and SP, marginal and internal adaptations were measured before and after the crystallization firing process. Data analyses were conducted using one-way ANOVA and the Tukey test. For IE and SP, marginal and internal adaptations before and after the crystallization firing process were analyzed using the t-test. The significance level was set at α=0.05.

RESULTS

One-way ANOVA revealed statistically significant differences in occlusal and cervical edge marginal adaptations among the material groups (p<0.001). The Tukey HSD test revealed a significant difference in marginal occlusal and cervical edge adaptations between LS and CD groups and IE and SP groups (p≤0.05). For IE and SP inlays, the t-test revealed a significant difference between occlusal and cervical edge adaptations before the crystallization firing process and those after the crystallization firing process, with the latter group showing a more significant discrepancy in adaptation than the former group (p≤0.05).

CONCLUSIONS

Fabrication methods (one- and two-step) affected the marginal adaptation compatibility but not internal compatibility of MO inlays. The crystallization firing process affected the marginal adaptation of inlays using lithium silicate or lithium disilicate glass-ceramics. However, adaptation to the cavity was considered clinically acceptable for all materials.

Is the digital workflow more efficient for manufacturing partial-coverage restorations? A systematic review

STATEMENT OF PROBLEM

A consensus on whether a fully digital workflow can replace conventional methods of manufacturing partial-coverage restorations is lacking.

PURPOSE

The purpose of this systematic review was to evaluate the accuracy, fit, and clinical outcomes of inlay, onlay, overlay, and endocrown restorations obtained with both digital and conventional workflows.

MATERIAL AND METHODS

This study complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in the International Prospective Register of Systematic Reviews database (CRD42021258696). Studies evaluating the accuracy, fit, and clinical outcomes of inlay, onlay, overlay, and endocrown restorations obtained with digital and conventional workflows were included from 5 databases searched in November 2022. The Checklist for Reporting Randomized Clinical Studies (ROB 2) and the Checklist for Reporting In vitro Studies (CRIS guidelines) were used to assess the risk of bias.

RESULTS

Twenty-three studies were included in this review. Sixteen studies evaluated marginal and internal fit, 5 evaluated accuracy, 3 evaluated fracture resistance, and 1 evaluated long-term clinical performance. Although most studies reported acceptable clinical outcomes for both workflows, 11 studies showed better results with the conventional workflow, 10 with the digital workflow, and 2 reported that the outcomes of the workflows were similar.

CONCLUSIONS

Clinically acceptable values have been reported for the parameters evaluated in both digital and conventional workflows, and no consensus has been reached regarding the more efficient method.

Performance of direct and indirect onlay restorations for structurally compromised teeth

STATEMENT OF PROBLEM

Research is lacking on the restoration of structurally compromised posterior teeth using direct composite resin or indirect restorations.

PURPOSE

The purpose of this in vitro study was to measure the fracture resistance and microleakage of different onlay restorations fabricated by using conventional and digital computer-aided design and computer-aided manufacturing (CAD-CAM) to restore structurally compromised teeth.

MATERIAL AND METHODS

Mandibular molars (n=54) were prepared for onlay restorations. Teeth were allocated to 3 groups (n=18) according to the type of restoration materials, nanohybrid composite resin (Grandio blocs), resin hybrid ceramic (SHOFU Block HC), and fiber-reinforced composite resin (everX Posterior). Onlays were bonded using a dual-polymerized adhesive resin cement. All specimens were thermocycled, followed by cyclic loading. Based on the type of investigation conducted, fracture resistance, and microleakage test, each group was then divided into 2 equal subgroups (n=9). The collected data were statistically analyzed with the chi-square of the Fischer exact test (α=.05).

RESULTS

Fracture resistance testing revealed a statistically significant difference between groups (P<.001). The fiber-reinforced composite resin demonstrated the highest fracture resistance, with statistically significantly less microleakage compared with the other groups (P=.013).

CONCLUSIONS

Direct fiber-reinforced composite resin could be considered a suitable alternative to CAD-CAM composite resin for the restoration of structurally compromised teeth.

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

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

Effect of three different preparation designs on the marginal adaptation of indirect overlay restoration fabricated from lithium disilicate ceramic material: An in-vitro comparative study

Objectives

Marginal adaptation is considered one of the key factors influencing the success of indirect restorations. This study aimed to estimate the marginal fit of lithium disilicate overlays with three distinct preparation designs before and after cementation.

Methods

Thirty maxillary first premolars were divided into the hollow chamfer design (HCD) group, butt-joint design (BJD) group, and conventional occlusal box design (COD) group (n = 10 each). The samples were scanned using an intra-oral scanner, and overlays were fabricated using computer-assisted design and milled on a computer-assisted machine. The finished restorations were luted using a self-adhesive resin RelyX Ultimate. The marginal gap was assessed using a digital microscope with 230X magnification power. Statistical analysis was conducted using analysis of variance and post hoc (Bonferroni correction) tests, assuming a significance level of 5%.

Results

The HCD and BJD groups recorded significantly lower marginal gap, (11.39 ± 0.72, 16.29 ± 0.75) and (11.59 ± 0.75, 16.93 ± 0.65) respectively, than the COD group (24.57 ± 1.18, 34.45 ± 1.09) both pre- and post-cementation.

Conclusion

This study demonstrated that modification of tooth preparation plays a significant role in the marginal adaptation of the lithium disilicate overlays. The gap was smaller with the HCD and BJD than with the COD, with a statistically significant difference.

Comparison of the Color Change of Porcelain Laminate Veneers Produced by Different Materials After Luting with Three Resin Cements

OBJECTIVES

This study aimed to compare color change of porcelain laminate veneers fabricated with two lithium disilicate ceramics and a zirconia-reinforced lithium silicate ceramic material after luting with conventional dual-cure, amine-free dual-cure, or light-cure resin cements using artificial accelerated aging (AAA).

METHODS AND MATERIALS

Ninety noncarious human maxillary central incisors were embedded in autopolymerizing acrylic resin blocks to prepare conventional laminate veneers with incisal coverage. Prepared teeth were randomly divided into 3 groups (n=30) to fabricate laminate veneer restorations using: (1) lithium disilicate ceramic, (2) lithium disilicate ceramic with high-density micronization, and (3) zirconia-reinforced lithium silicate ceramic. Impressions of the preparations were taken with a laboratory scanner. Acquired 3D images were processed into a surface tessellation language file. Data were exported for 3D printing on a printer, and laminate veneers were printed in castable wax resin. Ceramic veneers were heat-pressed after investment according to the manufacturer's recommendations and further divided into three groups (n=10) according to luting cement type: (1) light-cure resin cement, (2) amine-free dual-cure resin cement, and (3) conventional dual-cure resin cement. Color measurements were performed from the middle of each specimen with a spectrophotometer before and after AAA for 300 hours with a total energy of 150 kJ/m2. Color changes were calculated with the CIEDE 2000 (ΔE00) formula. Color differences were assessed using two-way analysis of variance (ANOVA) (α=0.05), and the paired t-test was used to compare the L*, a*, and b* parameters in each group before and after aging.

RESULTS

There were no significant differences between the ceramic groups (p>0.05). The color changes of the materials ranged from 2.26 to 3.13. All materials were above the clinically acceptable limit (ΔE00>1.8). The conventional dual-cure resin cement group showed more color change (p>0.05).

CONCLUSIONS

Color changes were observed in all porcelain laminate veneers after artificial accelerated aging. The zirconia-reinforced lithium silicate veneers showed similar color changes as lithium disilicate veneers; the amine-free dual-cure resin cement showed a similar color change as light-cure resin cement after aging.

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.

Triple scan evaluation of internal and marginal adaptation of overlays using different restorative materials

OBJECTIVE

Problems in the confection of indirect restorations may increase the marginal and internal gap. This study aimed to quantify the marginal and the internal fit of overlays fabricated with three different materials.

MATERIALS AND METHODS

Standardized cavities were prepared on endodontically treated human third molars and digital impressions were done using an intraoral camera (Trios 3). Restorations were designed (n = 15) and fabricated with three materials: Hybrid ceramic (Cerasmart; GC Corp, EUROPE), high-strength lithium disilicate (GC Initial® LiSi Press; GC Corp, Tokyo, Japan), and zirconia reinforced Lithium Silicate Glass Ceramic (Vita Suprinity; Vita, Germany). Axial, marginal, pulpal, and gingival gaps were calculated by measuring the distance between the restoration and the tooth at several reference points. Two-Way analysis of variance was used for statistical analysis. The significance level was set at α = 0.05.

RESULTS

Mean gap was significantly influenced by the material (p < 0.001), gap localization (p < 0.001), and interaction between the factors (p = 0.002). For all materials, the highest gap was observed at gingival and pulpal surfaces (p ≤ 0.015). LiSi Press achieved the overall lowest values at axial values measurements (p ≤ 0.003).

CONCLUSIONS

The performance of a CAD/CAM system relative to marginal adaptation is influenced by the restorative material used. High-strength lithium disilicate seems to be showed the best marginal adaptation.

CLINICAL SIGNIFICANCE

Marginal and internal adaptation of CAD/CAM restorations could be influenced by the type of material chosen.

CAD/CAM versus 3D-printing/pressed lithium disilicate monolithic crowns: Adaptation and fatigue behavior

OBJECTIVES

this study aimed to evaluate the adaptation and fatigue behavior of lithium disilicate glass-ceramic (LD) monolithic crowns produced by press (combined with 3D-printing) and CAD/CAM milling (control) techniques.

METHODS

thirty abutment preparations with a chamfer finish line were produced with a dentin analogue material and scanned with extraoral scanner. Captured images were processed using CAD software to design a premolar. Blocks of LD were milled using CAD/CAM system. For the press technique, crowns were first 3D-printed using a polymeric material and the heat-pressing protocol was performed. Crowns were adhesively cemented to the abutments and scanned using micro-CT. Files were processed and cross-sectional images were analysed in five measuring points: marginal, axial angle, axial, occlusal angle and occlusal. Fatigue test was performed in a MTS universal testing machine (2 Hz, 37°C distilled water) using an anatomic composite piston, following the step-stress method. Failures were detected with an acoustic system and confirmed by transillumination. A cumulative damage-Weibull distribution (95% CI) was used to analyze the fatigue data. Gap thickness data were analyzed using Kruskal-Wallis and Student-Newman-Keuls tests (α=0.05).

RESULTS

CAD/CAM milling resulted in larger gap thickness in the occlusal area and smaller gap thickness in the axial angle and axial area than press (p<0.05). The probability of failure was similar for crowns produced with CAD/CAM milling and press. The most frequent failure mode was radial crack.

CONCLUSIONS

LD crowns produced using the combination of 3D-printing/press technique showed similar fatigue behavior than CAD/CAM milled control group, and resulted in smaller gap thickness at the occlusal region.

CLINICAL SIGNIFICANCE

A more controlled process can be achieved by replacing conventional restoration waxing with 3D printing, which in combination with the press technique produces lithium disilicate glass-ceramic monolithic crowns with good adaptation and high fatigue survival.

Additive Manufacturing of Dental Ceramics: A Systematic Review and Meta-Analysis

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effect of using additive manufacturing (AM) for dental ceramic fabrication in comparison with subtractive manufacturing (SM), and to evaluate the effect of the type of AM technology on dental ceramic fabrication.

MATERIALS AND METHODS

A search was conducted electronically in MEDLINE (via PubMed), EBSCOhost, Scopus, and Cochran Library databases, and also by other methods (table of contents screening, backward and forward citations, and grey literature search) up to February 12, 2022, to identify records evaluating additive manufacturing of ceramics for dental purposes in comparison with subtractive manufacturing. A minimum of 2 review authors conducted tstudy selection, quality assessment, and data extraction. Quality assessment was performed with Joanna Briggs Institute tool, and the quantitative synthesis was performed with the Comprehensive Meta-Analysis program (CMA, Biostat Inc). Hedges's g for effect size was calculated, with 0.2 as small, 0.5 as medium, and 0.8 as large. Heterogeneity was assessed with I² and prediction interval (PI) statistics. Publication bias was investigated with funnel plots and grey literature search. Certainty of evidence was assessed with the Grading of Recommendations: Assessment, Development, and Evaluation (GRADE) tool.

RESULTS

A total of 28 studies were included for the qualitative and quantitative synthesis; 11 in vitro studies on accuracy, 1 in vivo study on color, and 16 in vitro studies on physical and mechanical properties. Meta-analysis showed overall higher accuracy for SM compared with AM, with medium effect size (0.679, CI: 0.173 to 1.185, p = 0.009) and also for marginal (g = 1.05, CI: 0.344 to 1.760, p = 0.004), occlusal (g = 2.24, CI: 0.718 to 3.766, p = 0.004), and total (g = 4.544, CI: -0.234 to 9.323, p = 0.062) with large effect size; whereas AM had higher accuracy than SM with small effect size for the external (g = -0.238, CI: -1.215 to 0.739), p = 0.633), and internal (g = -0.403, CI: -1.273 to 0.467, p = 0.364) surfaces. For technology, self-glazed zirconia protocol had the smallest effect size (g = -0.049, CI: -0.878 to 0.78, p = 0.907), followed by stereolithography (g = 0.305, CI: -0.289 to 0.9, p = 0.314), and digital light processing (g = 1.819, CI: 0.662 to 2.976, p = 0.002) technologies. Flexural strength was higher for ceramics made by SM in comparison to AM with large effect size (g = -2.868, CI: -4.371 to -1.365, p < 0.001). Only 1 study reported on color, favoring ceramics made through combined AM and SM.

CONCLUSIONS

Subtractive manufacturing had better overall accuracy, particularly for the marginal and occlusal areas, higher flexural strength, and more favorable hardness, fracture toughness, porosity, fatigue, and volumetric shrinkage; whereas AM had more favorable elastic modulus and wettability. Both methods had favorable biocompatibility. All studies on accuracy and mechanical properties were in vitro, with high heterogeneity and low to very low certainty of evidence. There is a lack of studies on color match and esthetics.

Marginal integrity and clinical evaluation of polyetheretherketone (PEEK) versus lithium disilicate (E-Max) endocrowns

Aim:  Evaluate the marginal integrity and Clinical performance of PEEK endocrowns compared to lithium disilicate (E-Max) ceramic endocrowns. Methodology: Twenty six endocrowns were fabricated for posterior endodontically treated teeth. Patients were divided into two groups according to the material used for fabrication of the restorations; Group 1(control group) received E-Max endocrowns while Group 2 (intervention group) received Bio HPP PEEK endocrowns. The marginal integrity and internal fit were assessed using the silicon replica approach, in which each replica was sectioned into four segments, each with five reference points that were evaluated using a digital microscope at 35X magnification. After final cementation, the clinical performance of the restorations was evaluated according to the USPHS criteria in terms of marginal adaptation, fracture, and retention. These measurements were repeated after three, six, nine and twelve months respectively. Results: The marginal and internal gaps of both groups were within the clinical acceptable range, but E-Max group recorded statistically significant higher internal gap mean value than PEEK group. Regarding the clinical performance all restorations showed 100% alpha and there was no significant difference between both groups for all tested outcomes (Marginal adaptation, fracture, and retention) over one year.

Composite Resin Preheating Techniques for Cementation of Indirect Restorations

Purpose

Resin-based materials have been preheated by using different techniques and commercial devices. However, a consensus on the clinical protocol for cementing with preheated composite resins is lacking. The aim of this scoping review was to identify the different methods used for heating composite resins as used for cementing indirect adhesive restorations and to determine the benefits and limitations. Study Selection. A search was performed on PubMed/MEDLINE, Embase, Cochrane, Web of Science, Scopus, LIVIVO, and the nonpeer-reviewed literature database. Studies on preheating composite resins for cementing indirect restorations were included, with no restrictions on the type of study, year of publication, or language. The following data were extracted: preheating technique, the device used for preheating, preset temperature, and warming time.

Results

In total, 304 studies were identified. After removing duplicates, 270 articles were selected, and 14 articles were included in the final evaluation. Half of the included studies reported similar preheating techniques using the Calset device for composite resins. The temperatures of 54°C and 68°C were most frequently reported, with a mean warming time of 5 minutes.

Conclusions

Preheating composite resins for the cementation of indirect restorations reduces viscosity, but the material must be used promptly after removal from the device. Practical Implications. Different methodologies for preheating composite resins have been reported and used in clinical dental practice. To achieve good results and guide the clinician on use, the techniques for heating composite resins for cementation need to be standardized. Keeping the material warm until the restorative procedure, the thickness of the indirect restoration, and the composition of the composite resins can directly affect the outcome of the procedure.

Fixed Prosthetic Restorations and Periodontal Health: A Narrative Review

Periodontal health plays an important role in the longevity of prosthodontic restorations. The issues of comparative assessment of prosthetic constructions are complicated and not fully understood. The aim of this article is to review and present the current knowledge regarding the various technical, clinical, and molecular aspects of different prosthetic biomaterials and highlight the interactions between periodontal health and prosthetic restorations. Articles on periodontal health and fixed dental prostheses were searched using the keywords “zirconium”, “CAD/CAM”, “dental ceramics”, “metal–ceramics”, “margin fit”, “crown”, “fixed dental prostheses”, “periodontium”, and “margin gap” in PubMed/Medline, Scopus, Google Scholar, and Science Direct. Further search criteria included being published in English, and between January 1981 and September 2021. Then, relevant articles were selected, included, and critically analyzed in this review. The margin of discrepancy results in the enhanced accumulation of dental biofilm, microleakage, hypersensitivity, margin discoloration, increased gingival crevicular fluid flow (GCF), recurrent caries, pulp infection and, lastly, periodontal lesion and bone loss, which can lead to the failure of prosthetic treatment. Before starting prosthetic treatment, the condition of the periodontal tissues should be assessed for their oral hygiene status, and gingival and periodontal conditions. Zirconium-based restorations made from computer-aided design and computer-aided manufacturing (CAD/CAM) technology provide better results, in terms of marginal fit, inflammation reduction, maintenance, and the restoration of periodontal health and oral hygiene, compared to constructions made by conventional methods, and from other alloys. Compared to subgingival margins, supragingival margins offer better oral hygiene, which can be maintained and does not lead to secondary caries or periodontal disease.

Does Resin Cement Type and Cement Preheating Influence the Marginal and Internal Fit of Lithium Disilicate Single Crowns?

This paper assesses the effect of cement type and cement preheating on the marginal and internal fit of lithium disilicate single crown. Methods: 40 maxillary premolars were selected, restored with lithium disilicate single crowns. Teeth were randomly assigned into four groups (n = 10) based on cement type (Panavia SA or LinkForce) and preheating temperature (25 °C or 54 °C). After fabrication of the restoration, cements were incubated at 25 °C or 54 °C for 24 h, and each crown was cemented to its corresponding tooth. After 24 h, all specimens were thermally aged to (10,000 thermal cycles between 5 °C and 55 °C), then load cycled for 240,000 cycles. Each specimen was then sectioned in bucco-palatal direction and inspected under a stereomicroscope at x45 magnification for marginal and internal fit evaluation. The data were statistically analyzed (significance at p ≤ 0.05 level). Results: At the mid-buccal finish line, mid-buccal wall, palatal cusp, mid-palatal wall, mid-palatal finish line, and palatal margin measuring points, there was a significant difference (p ≤ 0.05) between the lithium disilicate group cemented with Panavia SA at 25 °C and the group cemented with LinkForce at 25 °C, while there was no significant difference (p > 0.05) at the other points. At all measuring points, except at the palatal cusp tip (p = 0.948) and palatal margin (p = 0.103), there was a statistically significant difference (p ≤ 0.05) between the lithium disilicate group cemented with Panavia SA at 54 °C and the group cemented with LinkForce at 54 °C. Regardless of cement preheating, statistically significant differences were found in the buccal cusp tip, central groove, palatal cusp tip, and mid-palatal wall (p ≤ 0.05) in the lithium disilicate group cemented with Panavia SA at 25 °C and 54 °C, as well as the mid-palatal chamfer finish line and palatal margin in the LinkForce group cemented with Panavia SA at 25 °C and 54 °C. At the other measurement points, however, there was no significant difference (p > 0.05). Conclusions: The type of resin cement affects the internal and marginal fit of lithium disilicate crowns. At most measuring points, the cement preheating does not improve the internal and marginal fit of all lithium disilicate crowns.

Influence of filler geometry and viscosity of composite luting materials on marginal adhesive gap width and occlusal surface height of all-ceramic partial crowns

OBJECTIVES

To evaluate the influence of filler geometry and viscosity of luting composites on marginal adhesive gap width (MGW) and occlusal surface height (OSH) of all-ceramic partial crowns.

METHODS

Forty-eight all-ceramic partial crowns (Celtra Duo, Dentsply) were created and divided into six groups (n = 8). Restorations were bonded using universal adhesive (Prime & Bond Active, Dentsply) in combination with low-viscosity composites (LV) containing amorphous fillers (Calibra Ceram, Dentsply) (LV-AF), heterogeneous fillers (Tetric EvoFlow, Ivoclar Vivadent) (LV-HF) vs. high-viscosity composites (HV) containing spherical fillers (Ceram.x, Dentsply) (HV-SF) or heterogeneous fillers (Tetric EvoCeram, Ivoclar Vivadent) (HV-HF). HV materials were used either with or without sonication. MGW [µm] was measured by SEM. Displacements of the restorations after luting, such as changes (Δ) in OSH [µm], tilting and rotation [°], were measured using a dial gauge and 3D-analytical software (OraCeck, Cyfex). Statistical analysis was by Mann-Whitney U-test and t-test with α = 0.05.

RESULTS

MGW (p = 0.002) and tilting (p = 0.001) were significantly smaller with LV (228.0 ± 112.35 µm; 0.89 ± 1.25°) than with HV (338.1 ± 97.26 µm; 1.95 ± 1.26°). Sonication had no effect on MGW in HV-HF (332.32 ± 91.39 µm) and HV-SF (343.85 ± 105.48 µm; p = 0.74). Sonication decreased ΔOSH by ~50% with HV-SF (64.21 ± 27.90 µm) but remained unchanged with HV-HF (39.06 ± 14.08 µm; p = 0.004). There was no difference in rotation between HV (0.82 ± 0.81°) and LV (0.61 ± 0.74°; p = 0.29). The LV-AF and LV-HF groups showed no statistical differences in MGW, ΔOSH, tilting or rotation (p > 0.05).

SIGNIFICANCE

Irrespective of filler geometry and insertion technique, the use of high-viscosity composites for the adhesive cementation of modern all-ceramic partial crowns increases displacement, marginal misfit and occlusal surface height.

Comparison of the internal fit of metal crowns fabricated by traditional casting, computer numerical control milling, and three-dimensional printing

This experimental study aimed to compare the internal fit (marginal fit and internal discrepancy) of metal crowns fabricated by traditional casting and digital methods (computer numerically controlled (CNC) milling and three-dimensional [3D] printing). Thirty standard master abutment models were fabricated using a 3D printing technique with digital software. Metal crowns were fabricated by traditional casting, CNC milling, and 3D printing. The silicon replica method was used to measure the marginal and internal fit. A thin layer of low-viscosity polyvinyl siloxane material was placed inside each crown and on the die (like a seat) until the material was set. Replicas were examined at four reference points under a microscope: the central pit (M1), cusp tip (M2), axial wall (M3), and margin (M4). The measured data were analyzed using a one-way analysis of variance (ANOVA) to verify statistical significance, which was set at p < 0.05. In the traditional casting group, the minimum distance measured was at M3 (90.68 ± 14.4 μm) and the maximum distance measured was at M1 (145.12 ± 22 μm). In the milling group, the minimum distance measured was at M3 (71.85 ± 23.69 μm) and the maximum distance measured was at M1 (108.68 ± 10.52 μm). In the 3D printing group, the minimum distance measured was at M3 (100.59 ± 9.26 μm) and the maximum distance measured was at M1 (122.33 ± 7.66 μm). The mean discrepancy for the traditional casting, CNC milling, and 3D printing groups was 120.20, 92.15, and 111.85 μm, respectively, showing significant differences (P < 0.05). All three methods of metal crown fabrication, that is, traditional casting, CNC milling, and 3D printing, had values within the clinically acceptable range. The marginal and internal fit of the crown was far superior in the CNC milling method.

Effect of Deep Margin Elevation on Interfacial Gap Development of CAD/CAM Inlays after Thermomechanical Cycling

METHODS AND MATERIALS

Mesio-occlusal-distal cavities were prepared on 12 extracted mandibular molars. The gingival margin of one proximal box was elevated with resin modified glass ionomer (RMGI) by a height of 2 mm (Group E [elevation]), and the margin of the other side served as a control (Group NE [no elevation]). Lithium disilicate computer-aided design and computer-aided manufacturing (CAD/CAM) inlays were fabricated and bonded with a self-adhesive resin cement. An aging process was simulated on the specimens under thermomechanical cycling by using a chewing simulator. Marginal integration was evaluated under scanning electron miscroscopy (SEM) using epoxy resin replicas before and after cycling. Marginal areas were stained with silver nitrate solution, and the volumetric gap was measured at the bonded interfaces using micro-computed tomography (CT) before and after cycling. Statistical analyses were performed using paired t-tests, the Wilcoxon signed rank test, and the Mann-Whitney test (a<0.05).

RESULTS

SEM showed marginal discontinuities in Group NE that increased after thermomechanical cycling. Micro-computed tomography exhibited three-dimensional dye-penetrating patterns at the interfaces before and after cycling. Interfacial disintegration was larger in Group NE before cycling (p<0.05). Thermomechanical cycling increased the gaps in both Groups NE and E (p<0.05). The gap increment from thermomechanical cycling was larger in Group NE (p<0.05).

CONCLUSIONS

Thermomechanical cycling induced interfacial disintegration at the lithium disilicate CAD/CAM inlays, with deep proximal margins. Margin elevation with RMGI placement reduced the extent of the interfacial gap formation before and after the aging simulation.

A comparison of the marginal adaptation of composite overlays fabricated with silicone and an intraoral scanner

Background

Intraoral scanners have been developing during last years. The aim of this study was to know if digital impressions achieve a marginal adaptation in overlays as well as conventional impressions with silicone.

Material and Methods

Sixty-two extracted molars were selected. The samples were prepared for MOD overlays. The teeth were divided into two groups (n=31). Group 1: impressions were made with silicone (Express™ Impression, 3M ESPE) and overlays were manufactured with Sinfony composite (3M ESPE) by the laboratory technician. Group 2: impressions were taken with the scanner True Definition (TD, 3M ESPE) and under Lava Ultimate CAD/CAM Restorative composite (3M ESPE) were produced the restorations. Under 32x magnification images of vestibular, lingual, mesial and distal were capture in all the samples. Then the fit of the restorations was evaluated before and after cementation. Data were analysed statistically applying ANOVA and Bonferroni test.

Results

The marginal gap was better in TD group before (169,76 ± 54,15 µm) and after (145,16 ± 57,89 µm) cementation than in the silicone group (190,89 ± 58,18 µm) (187,47 ± 81,29 µm). The lowest marginal gap was in oclusal surface and the higher value was in the proximal margin for all the groups.

Conclusions

Digital impressions regarding marginal adaptation achieve better results than conventional impressions.

Key words:Composite onlays, overlays, restorative, CAD/CAM, intraoral scanner, silicone impressions, marginal adaptation.

Clinical Evaluation of Lithium Disilicate Veneers Manufactured by CAD/CAM Compared with Heat-pressed Methods: Randomized Controlled Clinical Trial

CLINICAL RELEVANCE

Lithium disilicate veneers for esthetic restorations show great accuracy and similarity, regardless of the type of fabrication technique.

SUMMARY

Comparative Evaluation of the Marginal Fit of Inlays Fabricated by Conventional and Digital Impression Techniques: A Stereomicroscopic Study

Context

Marginal fit being the prime concern of indirect restorations. Inlays can be either fabricated by conventional technique or computer-aided design and computer-aided manufacturing (CAD/CAM) techniques. CAD/CAM is the most evolving digital technique with faster, quicker, and precise results.

Aims

The aim of this study is to evaluate and compare the marginal fit of MOD inlays fabricated with two different CAD/CAM methods and conventional fabrication methods.

Settings and Design

Mesio-occlusal-distal preparation was done on a maxillary premolar typhodont tooth and divided into the following groups. Group A: 30 inlays were fabricated through the conventional impression technique. Group B: Preparation was scanning using an intraoral scanner followed by subtractive milling (Group B1) and subtractive milling of wax patterns (Group B2). Similarly, subgrouping was carried out for Group C except that an extraoral scanner was used. Occlusal and the cervical marginal fit were assessed using the replica technique and stereomicroscope. One-way ANOVA followed by Tukey honestly significant difference post hoc test for determining differences at a 95% level of confidence (P = 0.05).

Results

Group A had the highest marginal discrepancy in comparison to Group B and Group C at occlusal and cervical edges, whereas subtractive milling showed comparatively better results than subtractive milling of wax patterns at cervical edges and similar results at occlusal edges.

Conclusions

Ceramic inlays fabricated by subtractive milling yielded better results.

Marginal and internal adaptation of lithium disilicate partial restorations: A systematic review and meta-analysis

Aim:

The aim of this meta analysis was to evaluate the influence of the processing method on the marginal and internal gaps of lithium disilicate inlays/onlays.

Settings and Design:

A systematic literature review was conducted using the PubMed/Medline, Embase, Scopus, and Cochrane Library databases. This review was registered on the PROSPERO platform.

Materials and Methods:

The studies were selected according to the marginal and internal gaps of two different fabrication methods for lithium disilicate (milled and pressed).

Statistical Analysis Used:

The meta analysis was performed based on the Mantel–Haenszel and inverse variance methods, using the random effects model and a 95% confidence interval.

Results:

From all databases, 127 studies were identified. Four in vitro studies were included in the qualitative analysis and three in the meta analysis. Moreover, 197 restorations were evaluated (103 pressed and 94 milled). During the evaluation of only the internal gap, there was a statistically significant difference favoring the pressed technique (P = 0.002). There was no statistically significant difference in the analyses of the marginal gap (P = 0.530) and the total gap (P = 0.450).

Conclusion:

Both the techniques provided acceptable marginal and total gaps, although the pressed technique revealed a more favorable internal adaptation than the milled onlays/inlays.

Comparison of marginal and internal fit of pressed lithium disilicate veneers fabricated via a manual waxing technique versus a 3D printed technique

OBJECTIVE

The purpose of this in vitro study was to compare the marginal and internal fit of pressed lithium disilicate veneers fabricated from a 3D printed castable wax resin versus a manual waxing technique.

MATERIALS AND METHODS

A typodont model central incisor was prepared for a porcelain veneer. Following stone model fabrication from a polyvinyl siloxane impression, the model was digitized using a laboratory scanner. Group 1 veneers were designed digitally and 3D printed with a castable wax resin, then pressed. Group 2 veneers were fabricated using a manual wax and press approach. Veneers from both groups were bonded to printed dies. Following measurements of marginal adaptation under a stereo microscope, the dies were sectioned and measurements were made for internal adaption. Statistical analysis included a Kolmogorov test and a Mann-Whitney U test.

RESULTS

Average marginal gap (μm) for Group 1 was 40.37 ± 11.75 and 50.63 ± 16.99 for Group 2 (p = 0.51). Average internal gap (μm) for Group 1 was 61.21 ± 18.20 and 68.03 ± 14.07 for Group 2 (p = 0.178).

CONCLUSION

There was no difference in marginal fit or internal fit between pressed lithium disilicate veneers fabricated with a 3D printed castable resin and those fabricated with a manual waxing technique. The use of digital technologies and 3D printing provide significant advantages in the fabrication of pressed glass ceramic veneers, with marginal and internal adaptation comparable to manual wax and press techniques.

Influence of the Fabrication Technique on the Marginal and Internal Adaptation of Ceramic Onlays

This study aimed to evaluate the marginal and internal adaptation of partial coverage crowns (ceramic onlays) fabricated with Press, CEREC BlueCam, and CEREC OmniCam systems, using two preparation designs and evaluating the internal discrepancies at different locations. Two phantom maxillary premolars (master teeth) received different preparation designs, with (BX) and without (NB) a modified occlusal box with round internal angles. Sixty IPS e-max ceramic restorations were fabricated with three systems: Press (n=20), CEREC BlueCam (n=20), and CEREC OmniCam (n=20). Both marginal and internal discrepancy width were measured by using a stereomicroscope at ×25 magnification. The data were evaluated statistically using analysis of variance followed by Tukey's Honestly Significant Difference test (α=0.05). The ceramic restorations fabricated with the Press system presented significantly smaller marginal and internal disadaptations than the BlueCam and OmniCam CEREC systems (p&lt;0.0001). Regarding the preparation designs, preparation BX presented the smallest marginal discrepancies for all fabrication systems and larger internal discrepancies than for restorations fabricated with the Press system. The occlusal location presented a larger internal discrepancy compared with the axial locations. Although the three systems resulted in the fabrication of restorations within a clinically acceptable adaptation with marginal discrepancies below 100 μm, the Press system presented the smallest marginal and internal discrepancies. An improved marginal adaptation was observed in the preparation design with a modified occlusal box with rounded internal angles.

Effect of tooth preparation design on marginal adaptation of composite resin CAD-CAM onlays

STATEMENT OF PROBLEM

Although different preparation designs have been proposed for onlays fabricated by computer-aided design and computer-aided manufacturing (CAD-CAM), their effect on marginal adaptation is unclear.

PURPOSE

The purpose of this in vitro study was to investigate the effect of tooth preparation designs on the marginal and internal adaptation of ceramic-reinforced composite resin CAD-CAM onlays.

MATERIAL AND METHODS

A traditional preparation with a heavy chamfer on the functional cusp and a contrabevel on the nonfunctional cusp and a shoulder preparation with equal reduction on all cusps were used for mesial-occlusal-distal (MOD) onlay preparations. Ceramic-reinforced composite resin onlays were designed and milled based on the scanned prepared teeth. A digital silicone replica technique was used to determine marginal discrepancies between preparations and onlay restorations. A total of 100 numeric distances (representations of the fit in each region) were measured in 3 distinct regions: the buccal margin, lingual margin, and internal area. Independent Student t tests were used to determine significant differences (α=.05).

RESULTS

Traditional preparation designs resulted in significantly smaller overall discrepancies (50.9 ±0.5 μm and 139.1 ±5.4 μm, P<.001) and smaller marginal discrepancies in the buccal (49.7 ±1.4 μm and 135.8 ±2.2 μm, P<.001) and lingual areas (47.1 ±1.0 μm and 133.4 ±1.1 μm, P<.001).

CONCLUSIONS

The marginal adaptation of ceramic-reinforced composite resin CAD-CAM onlays was affected by the preparation design. The traditional preparation design offered better marginal adaptation; therefore, it is recommended in clinical practice.

Evaluation of two different CAD-CAM inlay-onlays in a split-mouth study: 2-year clinical follow-up

OBJECTIVE

To evaluate the clinical performance of hybrid ceramic inlay-onlay restorations over a 2-year period.

CLINICAL CONSIDERATIONS

A total of 30 lithium disilicate glass ceramic (LDC; control group) and 30 hybrid ceramic (HC; test group) inlay/onlay restorations were performed in 14 patients. Clinical evaluations were performed after 1 week, 6 months, 1 year, and 2 years of cementation according to the modified United States Public Health Service (USPHS) criteria, gingival index, and plaque index. The Friedman test was used for the significant difference in time and Wilcoxon signed-rank test was used for the determination of differences. The clinical parameters, gingival and plaque indexes differences in time were analyzed with Chi-square test. No statistically significant difference (P > .05) was found between the two groups in the modified USPHS, gingival index, and plaque index evaluations, whether statistically significant differences were found within groups. The total survival rate was 100% for both groups after 2 years.

CONCLUSION

Based on the 2-year data, the tested HC can be considered a reliable material for inlay/onlay restorations.

CLINICAL SIGNIFICANCE

The results of this in vivo study suggest that both resin nanoceramic materials and LDC materials have been successfully incorporated in treatments of inlay and onlay restorations. Short-term results showed that resin nanoceramic materials can be counted as a good choice in inlay and onlay restorations in an effort to reduce the treatment time associated with ceramic firing processes.

The Effect of Different Wax Pattern Fabrication Techniques on the Marginal Fit of Customized Lithium Disilicate Implant Abutments

PURPOSE

To evaluate the effect of different wax pattern fabrication techniques on the fit of customized pressed lithium disilicate implant abutments on titanium inserts before and after pressing. The marginal fit results of pressed lithium disilicate implant abutments were then compared with those of milled lithium disilicate abutments.

MATERIALS AND METHODS

After scanning the titanium inserts and designing an implant abutment, wax patterns were fabricated with three techniques (n = 15 each): computer-aided design/computer-aided manufacturing (CAD/CAM) milling, 3D printing and conventional layering. The marginal fit (µm) was measured using a stereomicroscope for all the wax patterns before pressing them into the lithium disilicate abutments. The pressed implant abutments were measured again for marginal fit, and the results were compared to those of the milled lithium disilicate abutments. One-way analysis of variance (ANOVA) was used to assess different wax pattern fabrication techniques in each stage before and after pressing. One-way ANOVA was also used to compare the groups of pressed and milled lithium disilicate abutments. Multiple pairwise comparisons were performed using the Tukey post hoc test in each stage.

RESULTS

There were statistically significant differences between the marginal fit of the three wax patterns groups (p < 0.001; f = 123.33), wherein the mean marginal fit was the highest for conventionally layered wax patterns (30 ± 13.09) µm. Furthermore, after pressing, there were statistically significant differences between the marginal fit of the three pressed abutments groups (p < 0.001; f = 518.62), wherein the mean marginal fit was the highest for pressed e.max abutments fabricated from conventionally layered wax patterns (25.26 ± 3.9) µm. There was no statistically significant difference between the mean marginal fit of the pressed abutments fabricated from conventional layered wax patterns and that of the milled CAD/CAM abutments. However, the mean marginal fit of the milled CAD/CAM abutments was higher than that of the pressed abutments fabricated from both CAD/CAM wax and 3D printed wax.

CONCLUSION

All the tested fabrication methods provided degrees of accuracy that lie well within accepted limits. The use of pressed lithium disilicate abutments fabricated from conventional layering wax pattern technique should provide a more consistent better marginal fit between the titanium insert and the abutment and may therefore be the preferable fabrication method.

On the wear behavior and damage mechanism of bonded interface: Ceramic vs resin composite inlays

Advances in adhesive technologies have increased indications for the use of inlays. Decrease in the bonded interface integrity due to wear has been cited as the main cause of its failure. However, this process of interface degradation and the influence of inlay material on damage mechanism appear to be poorly understood. Thus, we aimed to compare the wear behavior and interface damage between ceramic and resin composite inlays bonded to enamel under sliding contact and use the experimental findings to support recommendation of the appropriate inlay material. Bonded interface specimens involving tooth enamel and either ceramic or resin composite inlays were prepared and subjected to reciprocating wear tests up to 5×10⁴ cycles. The wear track profiles and morphologies were characterized after increments of cyclic sliding contact using white light interferometry and scanning electron microscopy, respectively. Optical microscopy was used to evaluate sub-surface cracks and their propagation within the samples. A finite element analysis was used to analyze the stress distributions of the bonded interfaces. Composite inlays showed higher wear depth than the ceramic in the early stage (N ≤ 5×10² cycles), while no significant difference was found at the later stage. For ceramic inlay a greater portion of the contact load was concentrated in the ceramic structure, which facilitated cracks and chipping of the ceramic inlay, with rather minimal damage in the adjacent interface and enamel. In contrast, for the resin composite inlay there was larger stress concentrated in the adjacent enamel, which caused the development of cracks and their propagation to the inner enamel. The restoration material could contribute to the stress distribution and extent of damage within enamel-inlay bonded interfaces. A tough ceramic appears to be more effective at protecting the residual dental tissue.

Current status on lithium disilicate and zirconia: a narrative review

Background

The introduction of the new generation of particle-filled and high strength ceramics, hybrid composites and technopolymers in the last decade has offered an extensive palette of dental materials broadening the clinical indications in fixed prosthodontics, in the light of minimally invasive dentistry dictates. Moreover, last years have seen a dramatic increase in the patients’ demand for non-metallic materials, sometimes induced by metal-phobia or alleged allergies. Therefore, the attention of scientific research has been progressively focusing on such materials, particularly on lithium disilicate and zirconia, in order to shed light on properties, indications and limitations of the new protagonists of the prosthetic scene.

Methods

This article is aimed at providing a narrative review regarding the state-of-the-art in the field of these popular ceramic materials, as to their physical-chemical, mechanical and optical properties, as well as to the proper dental applications, by means of scientific literature analysis and with reference to the authors’ clinical experience.

Results

A huge amount of data, sometimes conflicting, is available today. Both in vitro and in vivo studies pointed out the outstanding peculiarities of lithium disilicate and zirconia: unparalleled optical and esthetic properties, together with high biocompatibility, high mechanical resistance, reduced thickness and favorable wear behavior have been increasingly orientating the clinicians’ choice toward such ceramics.

Conclusions

The noticeable properties and versatility make lithium disilicate and zirconia materials of choice for modern prosthetic dentistry, requiring high esthetic and mechanical performances combined with a minimal invasive approach, so that the utilization of such metal-free ceramics has become more and more widespread over time.

Microstructural development during heat treatment of a commercially available dental-grade lithium disilicate glass-ceramic

OBJECTIVE

To elucidate the microstructural evolution of a commercial dental-grade lithium disilicate glass-ceramic using a wide battery of in-situ and ex-situ characterization techniques.

METHODS

In-situ X-ray thermo-diffractometry experiments were conducted on a commercially available dental-grade lithium disilicate glass-ceramic under both non-isothermal and isothermal heat treatments in air. These analyses were complemented by experiments of ex-situ X-ray diffractometry, field-emission scanning electron microscopy, energy-dispersive X-ray spectroscopy, differential scanning calorimetry, and field-emission scanning electron thermo-microscopy.

RESULTS

It was found that the non-fired blue block consists of ∼40 vol % crystals embedded in a glass matrix. The crystals are mainly lithium metasilicate (Li₂SiO₃) along with small amounts of lithium orthophosphate (Li₃PO₄) and lithium disilicate (Li₂Si₂O₅). Upon heating, the glassy matrix in the as-received block first crystallizes partially as SiO₂ (i.e., cristobalite) at ∼660 °C. Then, the SiO₂ crystals react with the original Li₂SiO₃ crystals at ∼735 °C, forming the desired Li₂Si₂O₅ crystals by a solid-state reaction in equimolar concentration (SiO₂ + Li₂SiO₃ → Li₂Si₂O₅). Precipitation of added colourant Ce ions in the form of CeO₂ appears at ∼775 °C. These events result in a glass-ceramic material with the aesthetic quality and mechanical integrity required for dental restorations. It also has a microstructure consisting essentially of elongated Li₂Si₂O₅ grains in a glassy matrix plus small cubic CeO₂ grains at the outermost part of the surface.

SIGNIFICANCE

It was found that by judiciously controlling the heat treatment parameters, it is possible to tailor the microstructure of the resulting glass-ceramics and thus optimizing their performance and lifespan as dental restorations.

The marginal discrepancy of lithium disilicate onlays: Computer-aided design versus press

Aim:

The aim of the study was to evaluate and compare the vertical marginal discrepancy of computer-aided design (CAD)/computer-aided manufacturing (CAM) and pressable lithium disilicate onlays.

Materials and Methods:

A maxillary first premolar typodont tooth was prepared to receive lithium disilicate onlay. Mesio-occluso-distal cavity was prepared with palatal cusp reduction and collar preparation. In the proximal box, gingival seat was placed 1 mm coronal to the cementoenamel junction and mesiodistal width of the seat was kept to 1 mm. Thirty stone models were prepared from thirty rubber base impressions and divided into two groups, based on the technique of fabrication of onlays: (1) Group CL (CAD/CAM lithium disilicate) and (2) Group PL (Pressable lithium disilicate). Fifteen onlays per each group were fabricated by following the manufacturer instructions. Marginal fit of all the samples were analyzed by using stereomicroscope with Image Analysis software. Statistical analysis was done by t-test.

Results:

Statistical significant difference was found between both the groups. The lowest marginal discrepancy (41.46 μm) was measured for Group CL (CAD/CAM lithium disilicate) specimens, and the highest (55.95 μm) discrepancy was observed on the Group PL (Pressable lithium disilicate) specimens.

Conclusion:

Although there was a statistically significant difference between the two groups, marginal gap of both the groups were in clinically acceptable levels.