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

Marginal adaptation analysis of CAD/CAM resin crown with non-invasive methods

OBJECTIVES

This study compared the silicone replica method with swept-source optical coherence tomography (SS-OCT) to analyze marginal adaptation and investigated the effect of the light incidence angle of SS-OCT on measurement precision.

MATERIALS AND METHODS

A typodont-prepared mandibular right first molar was scanned using an intraoral scanner (Trios 3). Fourteen crowns were fabricated from CAD/CAM resin blocks (Katana Avencia P) using a 5-axis milling machine (DWX-50). Marginal adaptation at the buccal, lingual, mesial, and distal points was assessed using the silicone replica method and SS-OCT at light incidence angles of 60°, 75°, and 90°. Statistical comparisons were performed using two-way analysis of variance (ANOVA) and t-tests with Bonferroni correction, and t-tests at a significance level of 0.05.

RESULTS

At 60°, SS-OCT showed significantly larger marginal discrepancies than the silicone replica method at the buccal, lingual, and mesial points (p < 0.05). At 75°, only the lingual point showed a significantly larger value than the silicone replica method (p < 0.05). At 90°, no significant differences were observed between the SS-OCT and silicone replica methods (p > 0.05). Marginal discrepancy values increased as the angle changed from 90° to 75° to 60°, with significant differences between 60° and 75° and between 60° and 90° at the buccal and lingual points (p < 0.05).

CONCLUSIONS

SS-OCT is a viable alternative to the silicone replica method for assessing marginal adaptation at an incidence angle of 90 °.

CLINICAL RELEVANCE

SS-OCT, a non-invasive method, has the potential to be applied clinically for evaluating marginal fit in indirect restorations in vivo.

Providing a monolithic zirconia fixed partial denture with rigid and nonrigid connectors to overcome nonparallel abutment teeth

This clinical report describes the fabrication of a monolithic zirconia fixed partial denture using rigid and nonrigid connectors to overcome nonparallel abutment teeth. A precise key and keyway in the ceramic material was designed with digital technology, reducing material costs, improving biocompatibility, and using esthetically superior nonmetallic materials.

Digital scans versus conventional impressions in fixed prosthodontics: An overview of systematic reviews

STATEMENT OF PROBLEM

Several systematic reviews have compared the accuracy of conventional impression making and digital recording techniques, with sometimes different results. A systematic overview of these studies is lacking.

PURPOSE

The purpose of this overview of systematic reviews was to examine the accuracy of digital scans and conventional impressions for tooth- or implant-supported fixed restorations in partially and completely edentulous adult patients.

MATERIAL AND METHODS

Four databases (Medline via PubMed, Scopus, Web of Science, and Google Scholar) were searched for systematic reviews according to preset eligibility criteria. Two calibrated evaluators screened and assessed the overall confidence of the included reviews using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool. Several review characteristics were recorded, including accuracy in terms of trueness and/or precision. The Jadad et al1 decision algorithm was used to select the best evidence, and a citation matrix was used to show overlaps in the studies.

RESULTS

From the 307 studies that were retrieved, 28 systematic reviews were included in this overview. Among these, 12 performed meta-analyses, and 18 comprised both in vitro and in vivo primary studies. Generally, digital scanning and conventional impression techniques for crowns and fixed partial dentures, for implant-supported fixed restorations, and for both tooth- and implant-supported restorations showed no statistically significant differences in terms of accuracy (trueness and precision) and marginal and internal adaptation (P>.05). However, conventional impressions outperformed digital scans for complete-arch fixed dental prostheses in terms of accuracy. Regarding methodological quality, most systematic reviews (67.9%) received critically low overall confidence based on AMSTAR 2.

CONCLUSIONS

No significant differences were reported in terms of marginal and internal fit between prosthetic restorations constructed after digital scanning and conventional impression making. The opportunity exists to enhance the methodological quality of systematic reviews with regard to the accuracy of dental recordings.

Accuracy and adaptation of one-piece endodontic crowns fabricated through 3D printing and milling

STATEMENT OF PROBLEM

High-level evidence regarding the accuracy and adaptation of 1-piece endodontic crowns fabricated by using 3-dimensional (3D) printing technology is lacking.

PURPOSE

The purpose of this in vitro study was to compare the accuracy and adaptation of 1-piece endodontic crowns produced through 3D printing and computer-numerical-control milling technology and to explore the influence of trueness on 1-piece endodontic crown adaptation.

MATERIAL AND METHODS

One-piece endodontic crowns were prepared for a typodont right mandibular first molar, scanned with a 3Shape E3 scanner, and designed with a computer-aided design software program. Two types of 1-piece endodontic crowns were fabricated: 3D printed by using resin and zirconia slurry and milled from Grandio and zirconia blocks. A reverse engineering software program was used to superimpose 4 groups of crowns with the reference crowns used for accuracy analysis. Microcomputed tomography was used to measure 1-piece endodontic crown adaptation. The correlation between trueness and adaptation was evaluated through the Spearman correlation test (α=.05).

RESULTS

Milled resin-based 1-piece endodontic crowns demonstrated better trueness on marginal and occlusal surfaces compared with 3D printed ones (P<.001). However, no significant difference was observed in the trueness of intaglio surfaces between the 2 groups (P>.05). The milled group exhibited better adaptations than the printed one (P<.05). For zirconia 1-piece endodontic crowns, no significant differences were found in trueness or adaptation between the milled and printed groups (P>.05). Notably, the trueness of the axial wall had the greatest impact on overall crown adaptation, with its adaptation closely linked to the trueness of each area, particularly the axial wall.

CONCLUSIONS

Milled resin-based 1-piece endodontic crowns exhibited higher levels of trueness and adaptation compared with 3D printed ones, while 3D printed zirconia 1-piece endodontic crowns were comparable with milled ones.

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

Background/purpose

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

Materials and methods

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

Results

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

Conclusion

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

Marginal Accuracy of Monolithic and Veneered Zirconia Crowns Fabricated by Conventional and Digital Workflows

PURPOSE

To compare the marginal accuracy of zirconia crowns fabricated by different workflows (conventional and digital) and designs (monolithic and veneered).

MATERIALS AND METHODS

A prepared maxillary first molar was used for the study. Four workflow combinations were evaluated: (1) intraoral scanning and monolithic zirconia (IOS-M), (2) intraoral scanning and veneered zirconia (IOS-V), (3) conventional impression and monolithic zirconia (IMP-M), and (4) conventional impression and veneered zirconia (IMP-V). All of the specimens had similar designs. The veneered groups had a buccal cutback for esthetic veneer application. A total of 10 crowns were produced in each workflow. The vertical and horizontal marginal accuracies were measured with a traveling microscope. Depending on the normality of the data, one-way analysis of variance test or Kruskal-Wallis test were applied to evaluate the differences among the groups (α = 0.05).

RESULTS

The most superior vertical marginal accuracy was observed for IOS-V (mean = 22.5 μm; SD = 6.7 μm), followed by IMP-V (mean = 23.9 μm; SD = 7.8 μm), IOS-M (mean = 28.7 μm; SD = 10.3 μm), and IMP-M (mean = 39.8 μm; SD = 22.0 μm), respectively (p < 0.001). The IOS-M had the greatest mean horizontal discrepancies (mean = 23.9 μm; SD = 4.3 μm) followed by IMP-M (mean = 21.3 μm; SD = 5.7 μm), IMP-V (mean = 19.2 μm; SD = 5.3 μm) and IOS-V (mean = 17.6 μm; SD = 5.7 μm) (p < 0.001).

CONCLUSIONS

Monolithic zirconia crowns fabricated digitally had superior marginal accuracy than monolithic zirconia crowns fabricated conventionally. Esthetic buccal veneering of predominantly monolithic zirconia copings improved the vertical and horizontal marginal accuracies.

Evaluation of Fitness and Accuracy of Milled and Three-Dimensionally Printed Inlays

OBJECTIVE

 This article compares and evaluates the marginal and internal fitness and three-dimensional (3D) accuracy of class II inlays fabricated using Tescera (TS) resin, milling of hybrid and zirconia blocks, and 3D printing with NextDent C&B.

MATERIALS AND METHODS

 Fifty-two mesio-occlusal inlays were fabricated using conventional method with TS, milling of Lava Ultimate (LU), milling of Zolid Fx multilayer (ZR), and 3D printing (n = 13 each). The marginal and internal fitness were evaluated at six points in the mesio-distal section of a replica under a digital microscope (160× magnification), and the accuracy was evaluated using 3D software. Analyses were conducted using t-test, one-way analysis of variance (ANOVA) and two-way ANOVA, while Duncan's multiple range test was used for post hoc analyses (α = 0.05).

RESULTS

 The marginal and internal fitness of the 3D and ZR were significantly superior to that of the TS and LU. For LU, ZR, and 3D, a significant discrepancy between the marginal gap and internal gap was observed (p < 0.05). On evaluating accuracy, trueness was significantly higher in ZR than in TS and LU; precision was significantly higher in 3D and ZR than in TS and LU (p < 0.05).

CONCLUSION

 The marginal and internal fitness and the accuracy of TS, ZR, and 3D were within the clinically acceptable range. The marginal and internal fitness and accuracy of 3D were better than those of TS and LU, which are commonly used in dentistry. There is immense potential for using 3D-printed inlays in routine clinical practice.

Micro-CT Marginal and Internal Fit Evaluation of CAD/CAM High-Performance Polymer Onlay Restorations

(1) Background: The use of high-performance polymers for fixed restorations requires additional studies regarding their adaptability and processing with CAD/CAM technology. This in vitro study aims to assess the marginal and internal fit of PEEK and PEKK materials using microcomputed tomography. (2) Methods: Twenty-four (n = 8) MOD onlays made of PEKK (Pekkton ivory), unmodified PEEK (Juvora medical), and modified PEEK (BioHPP) were investigated. A typodont mandibular left first molar was scanned to achieve 24 resin, 3D printed abutment teeth. The onlays were fabricated with a five-axis milling machine, and after cementation of the specimens, the marginal (MG) and internal gaps (IG) were evaluated at twelve points in the mesio-distal section and thirteen points in the bucco-lingual section using microcomputed tomography. For statistical data analysis, Wilcoxon signed-rank/paired Student t-Test, Mann-Whitney/unpaired Student t-Test, and one-way ANOVA test were applied. (3) Results: Significant differences (p < 0.05; α = 0.05) were reported between the MG and IG for each material for all three polymers and also among two materials in terms of the MG and IG (except Juvora-BioHPP). The highest IG values were recorded in angular areas (axio-gingival line angle) in the mesio-distal section for all the polymers. (4) Conclusions: For all the materials, MG < IG. The type of polymer influenced the adaptability; the lowest marginal and internal gap mean values were recorded for BioHPP. The analyzed polymer used for onlays are clinically acceptable in terms of adaptability.

Indirect restorative systems-A narrative review

OBJECTIVE

The background and clinical understanding of the properties of currently available indirect restorative systems and fabrication methods is, along with manufacturer and evidence-based literature, an important starting point to guide the clinical selection of materials for tooth and/or implant supported reconstructions. Therefore, this review explores most indirect restorative systems available in the market, especially all-ceramic, along with aspects of manufacturing process, clinical survival rates, and esthetic outcomes.

OVERVIEW

Progressive incorporation of new technologies in the dental field and advancements in materials science have enabled the development/improvement of indirect restorative systems and treatment concepts in oral rehabilitation, resulting in reliable and predictable workflows and successful esthetic and functional outcomes. Indirect restorative systems have evolved from metal ceramics and polymers to glass ceramics, polycrystalline ceramics, and resin-matrix ceramics, aiming to improve not only biological and mechanical properties, but especially the optical properties and esthetic quality of the reconstructions, in attempt to mimic natural teeth.

CONCLUSIONS

Based on several clinical research, materials, and patient-related parameters, a decision tree for the selection of indirect restorative materials was suggested to guide clinicians in the rehabilitation process.

CLINICAL SIGNIFICANCE

The pace of materials development is faster than that of clinical research aimed to support their use. Since no single material provides an ideal solution to every case, professionals must continuously seek information from well designed, long-term clinical trials in order to incorporate or not new materials and technological advancements.

Misfit of Implant-Supported Zirconia (Y-TZP) CAD-CAM Framework Compared to Non-Zirconia Frameworks: A Systematic Review

Objective: The aim of the study was to systematically review the overall outcomes of studies comparing the misfit of yttria-stabilized zirconia (Y-TZP) CAD-CAM implant-supported frameworks with frameworks fabricated with other materials and techniques. Methods: An electronic literature search of English literature was performed using Google Scholar, Scopus, Web of Science, MEDLINE (OVID), EMBASE, and PubMed, using predetermined inclusion criteria. Specific terms were utilized in conducting a search from the inception of the respective database up to May 2022. After the search strategy was applied, the data were extracted and the results were analyzed. The focused question was: Is the misfit of the implant-supported zirconia CAD-CAM framework lower than that of non-Y-TZP implant-supported fixed restorations? Results: Eleven articles were included for qualitative assessment and critical appraisal in this review. In the included studies, Y-TZP CAD-CAM implant-supported frameworks were compared to Titanium (Ti), Ni-Cr, Co-Cr, PEEK and high-density polymer, and cast and CAD-CAM frameworks. The studies used scanning electron microscopy, one-screw tests, digital or optical microscopy, 3D virtual assessment, and replica techniques for analyzing the misfit of frameworks. Six studies showed comparable misfits among the Y-TZP CAD-CAM frameworks and the controls. Three studies showed higher misfits for the Y-TZP CAD-CAM frameworks, whereas two studies reported lower misfits for Y-TZP CAD-CAM implant frameworks compared to controls. Conclusion: Y-TZP CAD-CAM implant-supported frameworks have comparable misfits to other implant-supported frameworks. However, due to heterogeneity in the methodologies of the included studies, the overall numerical misfit of the frameworks assessed in the reviewed studies is debatable.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.

X-ray microtomographic evaluation of the absolute marginal fit of fixed prostheses made from soft Co-Cr and zirconia

STATEMENT OF PROBLEM

The absolute marginal fit of CAD-CAM presintered fixed partial dentures has been poorly documented.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal fit of presintered cobalt-chromium (Co-Cr) and zirconia 3-unit fixed partial dentures by using X-ray microcomputed tomography (μCT).

MATERIAL AND METHODS

A metal model was prepared from a typodont to receive fixed partial dentures (N=12). The maxillary first premolar and first molar were prepared with a circumferential 1.2-mm chamfer and 2-mm occlusal reduction. The dies were scanned and assigned to 1 of 2 groups to receive the prostheses made of presintered Co-Cr or presintered zirconia (n=6). Each framework was seated on its model without load application. The abutments were scanned by using μCT. A circle with 10 diameters, with a step of 18 degrees, was projected at the center of the obtained image. Absolute marginal discrepancy and marginal gap mean values were measured, and overextended and underextended margins determined. The data were analyzed by using the Levene t test and ANOVA (α=.05).

RESULTS

No statistically significant difference was found in the marginal fit between the materials tested (P=.939). The mean values were 66 ±14 μm for Co-Cr and 61 ±12 μm for zirconia. The absolute marginal discrepancy mean value for the premolar was 69 ±12 μm and 41 ±9 μm for the molar (P<.001). Overextension was predominant for both materials tested, with a higher percentage reported for the zirconia group.

CONCLUSIONS

Presintered alloys presented clinically acceptable adaptation with a predominance of marginal overextensions.