Evaluation of the marginal fit of a CAD/CAM zirconia-based ceramic crown system

Marginal gap and internal fit of 3D printed versus milled monolithic zirconia crowns

BACKGROUND

This study aimed to evaluate and compare the marginal gap using two different methods and the internal fit of 3D printed and zirconia crowns.

METHODS

3Y-TZP zirconia crowns (n = 20) were manufactured using subtractive milling (group M) and 3D printed (group P). The marginal gap was measured at 60 points using vertical marginal gap technique (VMGT). On the other hand, the silicone replica technique (SRT) was used to evaluate the internal fit and was divided into 4 groups: marginal gap, cervical gap, axial gap, and occlusal gap where the thickness of light impression was measured at 16 references. The numerical data was tested for normality using Shapiro-Wilk's test. They were found to be normally distributed and were analyzed using an independent t-test.

RESULTS

Using VMGT, group P had significantly higher mean marginal gap values of 80 ± 30 µm compared to group M = 60 ± 20 µm (p < 0.001). Also, with the SRT, the marginal gap of group P (100 ± 10 µm) had significantly higher values compared to group M (60 ± 10 µm). The internal fit showed significant difference between the tested groups except for Axial Gap.

CONCLUSIONS

Although milled crowns showed better results. The 3D printed zirconia crowns offer clinically acceptable results in terms of marginal adaptation and internal fit. Both VMGT and SRT are reliable methods for the assessment of the marginal gap.

SEM Evaluation of the Marginal Accuracy of Zirconia, Lithium Disilicate, and Composite Single Crowns Created by CAD/CAM Method: Comparative Analysis of Different Materials

(1) Background: The objective of this in vitro study is to evaluate the marginal accuracy of crowns created by CAD/CAM. (2) Methods: A customized chrome-cobalt (Cr-Co) implant abutment simulating a maxillary right first molar was fixed in a hemi-maxillary stone model and scanned. In total, 27 crowns were fabricated, including 9 lithium disilicate crowns, 9 composite crowns, and 9 zirconia crowns. The measurements were determined by scanning electron microscopy. Descriptive analysis was performed using the mean and standard deviation, while the Kruskal-Wallis test was performed to determine whether the marginal discrepancies were significantly different between each group (p < 0.05). (3) Results: The lowest marginal gap value was reported for zirconia (21.45 ± 12.58 µm), followed by composite (44.7 ± 24.96 µm) and lithium disilicate (62.28 ± 51.8 µm). The Kruskal-Wallis tests revealed a statistically significant difference (p-value < 0.05) in the mean marginal gaps between different materials. (4) Conclusions: The proposed digital workflow can be a viable alternative for fixed prosthetic rehabilitations. The best performance in terms of marginal gap was achieved by zirconia crowns, but all three materials demonstrate marginal closure below the clinically accepted threshold value (120 µm). Clinical significance: although significant differences were reported, the investigated CAD/CAM materials showed clinically acceptable marginal gaps.

Evaluation of marginal and internal fit of lithium disilicate and zirconia all-ceramic CAD-CAM crowns using digital impressions: A systematic review

PURPOSE

A range of materials for single-tooth computer-aided design and computer-aided manufacturing (CAD-CAM) restorations have been introduced that may affect CAM accuracy. This study aimed to review articles evaluating marginal and internal fit of lithium disilicate (LD) and zirconia (Z) crowns fabricated by CAD-CAM systems using intraoral optical scanners (IOS).

MATERIALS AND METHODS

Under the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA), a systematic review was performed along with an electronic article search in the Medline/Pubmed database. The articles were limited to those in the English language that were published within the past ten years.

RESULTS

The initial search resulted in 50 articles and of those, a total of 18 articles were selected for full-text review following abstract evaluation. Eight articles that did not meet the inclusion criteria were excluded and the remaining ten articles, which provided internal and marginal gap values, were used in this review. For LD crowns, marginal gap values ranged between 45µm and 190.2µm. For Z crowns, the values varied between 39µm and 126.4µm. For LD crowns, the internal gap values were between 57.8µm and 475.4µm, and for Z crowns, the values were between 79µm and 205.8µm.

CONCLUSION

The outcome of this review suggests that clinically acceptable marginal and internal fit can be attained with LD and Z all-ceramic CAD-CAM crowns using digital impressions. Additionally, it has been found that LD and Z ceramics provide similar marginal gap values, but LD material provides better internal fit than Z.

Evaluation of the marginal fit of finish line designs of novel CAD/CAM restoration materials

Aim: The purpose of this study is to compare the marginal fit of crowns manufactured using different CAD/CAM materials on 2 different types of finish line design. Material and method: Tooth preparations were made by creating 2 different finish lines (rounded shoulder, chamfer) on an acrylic mandibular second premolar model. Impressions were taken on each preparation using polyvinylsiloxane impression material, and blocks with three different compositions including lithium disilicate (LDS), zirconia-reinforced lithium silicate (ZLS), and monolithic zirconia (MZ) (UP.CAD, Celtra Duo, and VITA YZ HT) were produced using a CAD/CAM (computer-aided-design and computer-aided-manufacturing) milling device (VHF R5) (n=10). The marginal gap values of the crown restorations were measured by the same operator using a stereomicroscope (LEICA DVM6). Histogram plots and the Kolmogorov-Smirnov test were used to test the normality of the distributions of the variables. The non-normally distributed (nonparametric) variables were compared using the Mann-Whitney U test for two groups and the Kruskal-Wallis test for more than two groups. Results: The marginal gap values were compared between finish line designs separately for each material. Accordingly, the marginal gap values of the rounded shoulder finish line were smaller than those of the chamfer finish line in all materials. The marginal gap values were also compared among the materials separately for each finish line type. Accordingly, the marginal gap values of the VITA YZ HT material were smaller than those of the Celtra Duo (ZLS) and UP.CAD (LDS) materials for both finish line designs. There was no significant difference between Celtra Duo and UP.CAD. Conclusion: The finish line design is a factor that affects marginal fit. Monolithic zirconia is more appropriate for clinical use as it shows a better marginal fit compared to LDS and ZLS.

Effect of Finish Line Design on the Fit Accuracy of CAD/CAM Monolithic Polymer-Infiltrated Ceramic-Network Fixed Dental Prostheses: An In Vitro Study

A polymer-infiltrated ceramic network (PICN) material has recently been introduced for dental use and evidence is developing regarding the fit accuracy of such crowns with different preparation designs. The aim of this in vitro study was to evaluate the precision of fit of machined monolithic PICN single crowns in comparison to lithium disilicate crowns in terms of marginal gap, internal gap, and absolute marginal discrepancies. A secondary aim was to assess the effect of finish line configuration on the fit accuracy of crowns made from the two materials. Two master metal dies were used to create forty stone dies, with twenty each for the two finish lines, shoulder and chamfer. The stone dies were scanned to produce virtual models, on which ceramic crowns were designed and milled, with ten each for the four material–finish line combinations (n = 10). Marginal gaps and absolute marginal discrepancies were evaluated at six pre-determined margin locations, and the internal gap was measured at 60 designated points using a stereomicroscope-based digital image analysis system. The influence of the material and finish line on the marginal and internal adaptation of crowns was assessed by analyzing the data using two-way analysis of variance (ANOVA), non-parametric, and Bonferroni multiple comparison post-hoc tests (α = 0.05). ANOVA revealed that the differences in the marginal gaps and the absolute marginal discrepancies between the two materials were significant (p < 0.05), but that those the finish line effect and the interaction were not significant (p > 0.05). Using the Mann–Whitney U test, the differences in IG for ‘material’ and ‘finish line’ were not found to be significant (p > 0.05). In conclusion, the finish line configuration did not seem to affect the marginal and internal adaptation of PICN and lithium disilicate crowns. The marginal gap of PICN crowns was below the clinically acceptable threshold of 120 µm.

Evaluation of Marginal/Internal Fit and Fracture Load of Monolithic Zirconia and Zirconia Lithium Silicate (ZLS) CAD/CAM Crown Systems

Fit accuracy and fracture strength of milled monolithic zirconia (Zi) and zirconia-reinforced lithium silicate (ZLS) crowns are important parameters determining the success of these restorations. This study aimed to evaluate and compare the marginal and internal fit of monolithic Zi and ZLS crowns, along with the fracture load, with and without mechanical aging. Thirty-two stone dies acquired from a customized master metal molar die were scanned, and ceramic crowns (16 Zi Ceramill Zolid HT⁺ and 16 ZLS Vita Suprinity) were designed and milled. Absolute marginal discrepancies (AMD), marginal gaps (MG), and internal gaps (IG) of the crowns, in relation to the master metal die, were evaluated using x-ray nanotomography (n = 16). Next, thirty-two metal dies were fabricated based on the master metal die, and crowns (16 Zi; 16 ZLS) cemented and divided into four groups of eight each; eight Zi with mechanical aging (MA), eight Zi without mechanical aging (WMA), eight ZLS (MA), and eight ZLS (WMA). Two groups of crowns (Zi-MA; ZLS-MA) were subjected to 500,000 mechanical cycles (200 ± 50 N, 10 Hz) followed by axial compressive strength testing of all crowns, until failure, and the values were recorded. Independent sample t tests (α = 0.05) revealed no significant differences between Zi and ZLS crowns (p > 0.05); for both internal and marginal gaps, however, there were significant differences in AMD (p < 0.005). Independent samples Mann–Whitney U and Kruskal–Wallis tests revealed significant differences between the two materials, Zi and ZLS, regardless of fatigue loading, and for the individual material groups based on aging (α = 0.05). Multiple comparisons using Bonferroni post-hoc analysis showed significant differences between Zi and ZLS material groups, with or without aging. Within the limitations of this study, the ZLS crown fit was found to be on par with Zi, except for the AMD parameter. As regards fracture resistance, both materials survived the normal range of masticatory forces, but the Zi crowns demonstrated greater resistance to fracture. The monolithic Zi and ZLS crowns seem suitable for clinical application, based on the fit and fracture strength values obtained.

Evaluation of Marginal and Internal Fit of a CAD/CAM Monolithic Zirconia-Reinforced Lithium Silicate Porcelain Laminate Veneer System

PURPOSE

To evaluate the marginal and internal fit of monolithic computer-aided design/computer-aided manufacturing (CAD/CAM) ZLS (Vita Suprinity) glass ceramic porcelain laminate veneers (PLVs), in terms of marginal and internal gap widths, in comparison to monolithic lithium disilicate (LDS) [IPS e.max CAD] CAD/CAM veneers, and, also, to analyze the effect of incisal preparation designs (butt joint and chamfer), on the marginal and internal fit accuracy.

MATERIALS AND METHODS

Forty dental stone dies poured from impressions made of two master metal dies with different incisal preparation designs were scanned to produce digital models. Forty ceramic veneers were designed and milled using the virtual models-10 ZLS butt joint, 10 ZLS chamfer, 10 LDS butt joint, and 10 LDS chamfer. The monolithic ceramic veneers produced were then subjected to marginal and internal gap width evaluation using X-ray nano-computed tomography and computerized digital analysis (n = 10). Descriptive analyses of data were performed and the influence of "material" and "preparation design" on the marginal and internal fit of veneers was assessed using 2-way ANOVA (α = 0.05). Bonferroni post-hoc multiple comparison tests were used to further analyze the interactions between the material and preparation design after adjusting the α value by Holm-Bonferroni method (α = 0.01).

RESULTS

Mean marginal and internal gaps for ZLS PLVs were 65 ±11 μm and 112 ±14 μm for butt joint, and 100 ±24 μm and 100 ±21 μm for chamfer, respectively. Corresponding values for LDS PLVs were 78 ±25 μm and 114 ±17 μm for butt joint, and 104 ±18 μm and 106 ±7 μm for chamfer. Marginal gap and internal gap differences between ZLS and LDS PLVs were not significant (marginal gap: F = 1.786, p = 0.190; internal gap: F = 0.807, p = 0.375). However, the preparation designs (butt joint and chamfer) differed significantly in terms of marginal gaps (F = 23.797, p = 0.000), but not internal gaps (F = 3.703; p = 0.059).

CONCLUSIONS

Butt joint margins produced better marginal accuracy in terms of marginal gap, compared to chamfers, for ZLS CAD/CAM laminate veneers.