The fit of gold inlays and three ceramic inlay systems. A clinical and in vitro study

Accuracy of merging scans of definitive fixed prosthodontic impressions to obtain single, accurate digitized master casts

PURPOSE

Many elastomeric impressions sent to commercial laboratory dental technicians may include marginal defects. To fabricate accurate restorations, digital technology may be used to merge digital files of defective impressions into a single standard tessellation language (STL) file free of errors. This would save clinicians and patients time and may improve clinical care. The purpose of this study was to compare the accuracy of digital master casts reconstructed from merged STL files of defective impressions with the file of the original defect-free preparations.

MATERIAL AND METHODS

Ivorine teeth on a dentoform were prepared to receive a posterior fixed dental prosthesis (FDP) with complete coverage preparations. An impression was made in a stock tray using polyvinyl siloxane (PVS) impression material and an extraoral scanner (E3, 3Shape, Denmark) was used to digitize the impression; this was the reference cast. Wax was used to create defects on the buccal and lingual margins of the preparations. Fifteen PVS impressions were made of the FDP preparations with defects in the mesial and distal margins; another set of 15 PVS impressions was made of FDP preparations with defects in the buccal and palatal margins for a total of 30 impressions. All impressions were digitized using the same extraoral scanner (E3, 3Shape, Denmark). Corresponding STL files were paired and merged, and a master cast was created by eliminating the defects using the scanned data. This master cast was compared to the reference cast using reverse engineering software (Geomagic, Morrisville, NC, USA). The results were expressed as average errors and standard deviations in the master casts relative to the reference cast. To account for the presence of positive and negative values in the data set, in terms of errors, the root mean square (RMS) value was calculated for each sample.

RESULTS

The mean average error in the sample was -0.4 μm. The average upper limit of 95% confidence interval was +36.5 μm, while the average lower limit of 95% confidence interval was -37.3 μm. The mean RMS of the errors found was 18.9 μm.

CONCLUSIONS

The results of this study indicated that merging digitized definitive impressions to correct marginal defects resulted in master casts with a high level of accuracy relative to the reference cast.

Internal adaptation assessment of implant infrastructures manufactured through five different techniques (heat-press, milling, lost wax, calcinable cylinder, and CAD/Waxx®): an in vitro pilot study

Introduction

The aim of this study was to evaluate the fit performance of implant infrastructures manufactured by five different techniques: heat-press (IPS), milling (ZIR), lost wax (CER), calcinable cylinder (CAL), and CAD/Waxx® (CAD).

Methods

The methodology was based on the Replica Technique, which can simulate and evaluate the fit of the infrastructure on the implant component. Thus, each infrastructure was internally filled with low-viscosity silicone addition and seated on the component until its final setting, obtaining the replica of the cementation space. After removing the coping containing the silicone film, light-density silicone was inserted addition in place of the components, and in its surroundings, condensation silicone was applied, establishing support for the assembly. The joint was sectioned mesiodistally, photographed, and analyzed in image processing software in order to measure the thickness of the interface infrastructure/implant at five different areas: marginal opening (M), gingival-axial angle (G-A), axial region (A), axial-occlusal angle (A-O) and occlusal surface (O).

Results

The lowest and the highest average thickness between groups was, respectively, IPS: 187.5 μm and CAD: 221.6 μm, with statistically significant differences (p < 0.01) among all five groups; the lowest and the highest average of all groups in each point was, respectively, A: 99.86 μm and O: 279.78 μm. The IPS group exhibited the lowest value of the internal space of the infrastructure on the implant. The marginal region of all groups demonstrated a correlation with the findings in the literature, except the CAL group; otherwise, the occlusal region and the angles A-O and G-A exhibited values beyond that expected.

Discussion

It was possible to conclude that the five infrastructure groups presented different adaptations, suggesting possible interference in the internal spaces due to the manufacturing infrastructure processes.

The Effect of Firing Cycles on the Fit of Cobalt-Chromium Multiunit Prostheses Fabricated by Additive Manufacturing

PURPOSE

The effect of annealing and firing cycle on the adaptation of cobalt-chromium (CoCr) restorations fabricated by additive manufacturing has been poorly documented. This study compared the marginal and internal fit of CoCr three-unit fixed dental prostheses before and after firing cycles.

MATERIAL AND METHODS

The first right maxillary premolar (MP) and molar (MM) on a typodont model, were prepared with a circumferential 1.2 mm chamfer, 2 mm occlusal reduction, and total taper of 8 degrees, to receive 3-unit fixed dental prostheses (FDP). After the framework design, 20 framework specimens were fabricated using CoCr metal powder by selective laser melting. The replica technique was used for marginal and internal fit measurements in mesiodistal and buccolingual planes. The specimens were submitted to an annealing process, and to ceramic firing protocol. Measurements were repeated after each firing cycle. The data were compared by using Levene test, t-test, and analysis of variance (ANOVA) (α = 0.05).

RESULTS

A significant difference was found in the total intaglio surface discrepancy between the 3 treatments. The annealing treatment induced a statistical difference in the discrepancy value compared to the as printed state (p = 0.028). A significant difference was detected between the initial manufacturing phase and the ceramic layering firing cycle (p = 0.003).

CONCLUSIONS

Firing cycles induced an alteration of the frameworks adaptation.

Comparative assessment of marginal and internal gaps of cast-free monolithic zirconia crowns fabricated from 2 intraoral scanners: A prospective, double-blind, randomized clinical trial

STATEMENT OF PROBLEM

Despite the introduction of intraoral scanners (IOSs) with dual camera triangulation, only a few comparative clinical studies have evaluated their clinical performances in the digital workflow for cast-free restorations.

PURPOSE

The purpose of this clinical trial was to assess the clinical efficacy of 2 different technology-based IOSs by evaluating the marginal and internal gaps of cast-free monolithic zirconia crowns fabricated by using a fully digital workflow.

MATERIAL AND METHODS

A prospective randomized clinical trial was conducted in 35 participants requiring a single-unit restoration. One crown was fabricated from the scan data obtained with a confocal microscopy-based IOS (Group T), while the other was made with the scan data obtained from an IOS using dual camera triangulation (Group I). A replica technique was used to assess the marginal and internal gaps. The buccolingual and mesiodistal cross-sections were measured, and noninferiority trials were performed.

RESULTS

A total of 39 teeth from 35 participants were restored with a single-unit crown. The marginal and axial wall gaps of the crowns in Group I was not inferior to that of the crowns in Group T (upper limit confidence interval [CI] <30). In contrast, the gap of the crowns at the line angle in Group T was inferior to that of the crowns in Group I (lower limit CI <-30). From an occlusal space perspective, the gap of the crowns in Group I was inferior to that of the crowns in Group T (upper limit CI >30). Twenty-five crowns were selected from Group I, and 14 crowns were selected from Group T for definitive placement.

CONCLUSIONS

The marginal gap of the crown fabricated by using the scan data obtained from the dual camera triangulation-based IOS was noninferior to that obtained from the confocal microscopy-based IOS and was within the clinically applicable limit.

A Scoping Review of Marginal and Internal Fit Accuracy of Lithium Disilicate Restorations

OBJECTIVE

To assess and compare the accuracy of the marginal and internal fit of lithium disilicate crowns and onlays fabricated by conventional and digital methods.

SOURCES

An electronic search was carried out on MEDLINE, Embase, Web of Science and Cochrane Library between 2010 and 2021.

STUDY SELECTION

Seventeen studies published between 2014 & 2021 were included, of which thirteen were in vitro laboratory-based studies; three were in vivo clinical studies and one randomised controlled trial.

DATA

Twelve studies focused on the marginal fit, five focused on the marginal and internal fit. Five studies found that the marginal and internal fit of crowns were more accurate using digital techniques. Five studies noted that there was no difference using either technique and two noted that conventional methods had a more accurate marginal fit.

CONCLUSION

Digital techniques were comparable to conventional methods in terms of accuracy although there was insufficient evidence to indicate that one technique was more accurate than the other with respect to Lithium Disilicate restorations.

CLINICAL SIGNIFICANCE

Digital impressions are reliable and viable alternatives for clinicians compared to conventional impression techniques when restoring teeth with lithium disilicate restorations.

Marginal Adaptation and Internal Fit of 3D-Printed Provisional Crowns and Fixed Dental Prosthesis Resins Compared to CAD/CAM-Milled and Conventional Provisional Resins: A Systematic Review and Meta-Analysis

The aim of this systematic review was to evaluate the marginal fit and internal adaptation of provisional crowns and fixed dental prostheses (FDPs) fabricated using 3D-printing resins and compared them with those fabricated by CAD/CAM (computer-aided designing/computer-aided manufacturing) milling and conventional resins. The null hypotheses tested were that there would be no differences in the marginal fit and internal adaptation of 3D-printed provisional crowns and FDP resins when compared to CAD/CAM-milled and conventional provisional resins. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to construct this systematic review. The focused PICO/PECO (Population, Intervention/Exposure, Comparison, Outcome) question was “Do provisional crowns and FDPs (P) fabricated by 3D-printing (I) have similar marginal adaptation and internal fit (O) when compared to those fabricated by CAD/CAM milling and conventional techniques (C)?”. The protocol used for this systematic review was pre-registered in the International Prospective Register of Systematic Reviews (PROSPERO). Electronic databases (e.g., MEDLINE/PubMed and Web of Science (Core Collection)) were systematically searched for indexed English literature published up to June 2022. In the initial electronic search of the selected databases, 519 articles were identified. Duplicates were removed, and screening was performed to select the articles that met the preset inclusion criteria. Sixteen studies were selected for qualitative analysis, but only ten of them provided comparative data and were selected for quantitative analysis. The modified CONSORT scale was used for qualitative analysis, and most of the included studies were rated to be of moderate quality. Based on the findings, it could be concluded that provisional crowns and FDPs fabricated from 3D-printing resins have a superior marginal fit and internal adaptation when compared to CAD/CAM-milled and conventional provisional resins; thus, they can be used as a dependable alternative to other resins.

Digital assessment of marginal accuracy in ceramic crowns fabricated with different marginal finish line configurations

AIM

To digitally evaluate the marginal adaptation of different types of all-ceramic crowns on two different marginal configurations such as Shoulder and Chamfer of the prepared teeth.

METHODS

The marginal fit of the crown specimens on the model of the prepared teeth were assessed using the dual scan replica technique. Two plastic teeth were prepared; one having a Shoulder finishing line (A), while the other with a Chamfer finish line (B). Three types of different all-ceramic crowns, layered zirconia, monolithic zirconia, and pressed lithium disilicate, were fabricated for each prepared tooth (A) and (B). Measurements for assessing the marginal discrepancy were done on four designated points on the mesial, distal, buccal, and palatal surface of the superimposed image.

RESULTS

The average marginal gap was the largest in the layered zirconia group, followed by monolithic zirconia, while pressed lithium disilicate crowns showed the least marginal gaps. Crowns with Chamfer finish lines were better fitting (less marginal gap) than the shoulder finish lines across all the groups.

CONCLUSIONS

Chamfer finish lines produced better fitting restorations, and heat-pressed lithium disilicate crowns showed better adaptation at the margins than both layered zirconia and monolithic zirconia.

Marginal and internal fit of crowns based on additive or subtractive manufacturing

OBJECTIVE

To assess the marginal and internal fit of crowns manufactured by additive and subtractive manufacturing technique.

MATERIALS AND METHODS

Twenty extracted teeth prepared for complete coverage crowns were scanned with an intra-oral scanner (Omnicam, DentsplySirona). For the subtractive manufacturing (SM) group, ten crowns were manufactured in a hybrid resin block (Vita Enamic, Vita Zahnfabrik). For the additive manufacturing (AM) group, the crowns were manufactured in a hybrid resin material (NextDent C&B, 3D systems). The design parameters were identical for the two groups. The marginal and internal fit (determined at the axial wall, the cusp tip and occlusally) was assessed before cementation with the replica technique and after cementation under stereomicroscope after sectioning of the crowned teeth.

RESULTS

For the SM group, the marginal fit was 91 µm (±28 µm) before cementation and 85 µm (±18 µm) after cementation. In the AM group, the marginal fit was 75 µm (±29 µm) before cementation and 71 µm (±18 µm) after cementation. The differences were not statistically significant. As regards the internal fit, the fit at the axial wall was statistically significantly better in the SM group than in the AM group (p=.009 before cementation and .03 after cementation). Occlusally the fit in the AM group was significantly better than in the SM group after cementation (p<.001).

CONCLUSION

Within the limitations of the current study, the marginal fit of additively manufactured crowns is comparable to crowns manufactured with chair-side subtractive technique and within the clinically acceptable range. As regards the internal fit no one technique was consistently superior.

Evaluation of fits of metal copings fabricated by using selective laser melting at various angles

STATEMENT OF PROBLEM

Information on the fabrication of metal by selective laser melting (SLM) systems positioned at different angles is sparse.

PURPOSE

The purpose of this in vitro study was to evaluate the extent of marginal and internal gaps in metal copings fabricated at different angles by using an SLM fabrication system.

MATERIAL AND METHODS

A master metal model was produced and replicated (N=10) with silicone impressions and dental stone. Standard tessellation language (STL) files of the 10 coping designs were then obtained by using a model scanner and a 3D design software program on a scannable working die. Co-Cr alloy metal copings were fabricated by the SLM fabrication system at 45, 90, and 180 degrees. The marginal and internal gaps were measured by the silicone replica technique. The measured data were analyzed by using the nonparametric Kruskal-Wallis H test (α=.05).

RESULTS

The specimens fabricated at 180 degrees showed the best fit in terms of the marginal gap, while the worst fit was observed in the specimens fabricated at 90 degrees. Statistically significant differences were seen among the marginal gaps produced in the 3 groups (P<.001). In terms of internal fit, the axial wall gap showed the best fit, and the occlusal gap the worst. The best fit overall was 66 μm at the axial wall of the 180-degree group, and the worst in the 90-degree group, at 663 μm. Statistically significant differences were observed between the chamfers, axial walls, and the occlusal gaps of the 3 groups (P<.001).

CONCLUSIONS

Restorations fabricated by using an SLM system at 180 degrees were clinically acceptable. However, more research is required to investigate the performance of metal copings produced at 45 and 90 degrees to evaluate their clinical acceptability.

Fit Alteration of Presintered Co-Cr and Zirconia Multiple-Unit Prostheses After Ceramic Layering

PURPOSE

The fit alteration after ceramic layering of soft Cobalt-Chromium (Co-Cr) and zirconia is poorly documented. This study compared the marginal and internal fit of presintered Co-Cr and zirconia three-unit fixed dental prostheses before and after ceramic veneering.

MATERIALS AND METHODS

Co-Cr master model was prepared and duplicated 60 times to receive three-unit fixed dental prostheses (FDPs). Sixty dies were prepared, scanned and assigned to 3 groups (n = 20/group), to receive the FDPs made of presintered Co-Cr (CS), presintered zirconia (CZ) and cast Ni-Cr (Wi). Each framework was seated on its specific cast. A replica technique was used for marginal and internal discrepancy measurements in mesiodistal and buccolingual planes. Frameworks were ceramic veneered. Results were compared before and after ceramic layering within each group. Data were analyzed using the Levene, t test, and ANOVA (α = 0.05).

RESULTS

Significant difference was found when gaps were compared within groups for CS and CZ but not for Wi. At the abutments level, significant difference was found for both premolars and molars in the buccolingual planes (p < 0.001). A multiple comparison between materials tested showed significant differences between presintered and cast Ni-Cr. No significant difference was detected between CS and CZ (p = 1.000).

CONCLUSIONS

Although ceramic layering increased the discrepancy for presintered Co-Cr and zirconia, the marginal adaptation remained clinically acceptable.

Effect of materials on axial displacement and internal discrepancy of cement-retained implant-supported prostheses

STATEMENT OF PROBLEM

How axial displacement may be affected by the mechanical properties and internal discrepancy of a cement-retained implant-supported prosthesis is unclear.

PURPOSE

The purpose of this in vitro study was to assess the difference in internal discrepancy and axial displacement according to the prosthesis material in cement-retained prostheses splinting nonparallel implants.

MATERIAL AND METHODS

Computer-aided design and computer-aided manufacture (CAD-CAM) titanium abutments were fabricated for a vertically placed implant and a 15-degree tilted implant. Three types of prostheses, in zirconia, cobalt-chromium (Co-Cr) alloy, and polymethylmethacrylate resin (PMMA), were fabricated (n=10). The internal discrepancy between the CAD-CAM titanium abutment and the prosthesis was measured by using the replica technique. After luting with an interim cement, they were mounted in Type IV gypsum. The specimens were cyclic loaded, and axial displacement of the prosthesis was measured after 3, 10, 100, and 10⁶ cycles. The internal discrepancy and cumulative axial displacement were assessed by using a 3-way analysis of variance and repeated measures analysis of variance (α=.05).

RESULTS

The internal discrepancy of the prosthesis did not differ based on the prosthesis material (P=.869); however, it was significantly different based on the measurement location, with the occlusal discrepancy (224 ±29 μm) being greater than the axial discrepancy (21 ±10 μm) (P<.05). Implants with an angled placement exhibited less axial displacement than implants with vertical placement (P<.05). The PMMA prosthesis demonstrated significantly greater axial displacement than the zirconia or Co-Cr prostheses (P<.05), which were similar (P=.623).

CONCLUSIONS

Prostheses made with high-elastic moduli materials exhibited less axial displacement than PMMA prostheses, even though the internal discrepancy was not different. Moreover, vertically placed implants presented a greater axial displacement of the prosthesis than implants with angled placement.

Clinical evaluation of the fit of lithium disilicate crowns fabricated with three different CAD-CAM systems

STATEMENT OF PROBLEM

The fit and performance of prostheses fabricated using various computer-aided design and computer-aided manufacturing (CAD-CAM) systems have been evaluated. However, most studies were conducted in vitro, and relatively few have addressed gingival parameters and prosthesis fit under clinical conditions.

PURPOSE

This clinical study aimed to compare the fit of lithium disilicate crowns produced using 3 CAD-CAM systems and evaluate clinical results up to 6 months after delivery.

MATERIAL AND METHODS

Forty participants requiring a single crown were recruited. Three monolithic lithium disilicate crowns were fabricated per participant by using 3 different CAD-CAM systems (intraoral scanners, CAD software, and milling machines): CEREC group (CEREC Bluecam, CEREC AC, CEREC MC); EZIS group (EZIS PO, EZIS VR, EZIS HM); and TRIOS group (TRIOS 3, EXO-CAD, ARUM-4X). The fit of the prostheses was assessed via a silicone replica technique, and the most acceptable crown was delivered; 12 were selected from the CEREC group, 16 from the EZIS group, and 12 from the TRIOS group. Follow-up clinical examinations were performed at 1, 3, and 6 months after delivery. The Kruskal-Wallis test with the post hoc Mann-Whitney U test was conducted to analyze significant differences in crown fit and periodontal conditions among the groups (α=.05).

RESULTS

The marginal gap of the CEREC group was significantly higher than that of the EZIS group, and the occlusal gap of the EZIS group was significantly lower than those of the CEREC and TRIOS groups (P<.05). Probing depth, bleeding index, and plaque index showed no intergroup differences at 6 months (P>.05).

CONCLUSIONS

The lithium disilicate crowns of all groups showed clinically acceptable fit. No significant differences were found among the groups in terms of periodontal conditions after 6 months.

Marginal and internal fit of three-unit fixed dental prostheses fabricated from translucent multicolored zirconia: Framework versus complete contour design

STATEMENT OF PROBLEM

Translucent multicolored zirconia materials enable more esthetic complete contour zirconia fixed dental prostheses (FDPs) than conventional zirconia, which exhibits low translucency and high opacity and is monochromatic. However, how the marginal and internal fit of translucent multicolored zirconia FDPs compare with those of traditional frameworks that require veneering is unclear.

PURPOSE

The purpose of this in vitro study was to compare the marginal and internal fit of frameworks and complete contour 3-unit FDPs fabricated from translucent multicolored zirconia.

MATERIAL AND METHODS

Frameworks with a thickness of 0.5 mm and complete contour FDPs with a thickness of 0.8 to 1.5 mm were manufactured by using a workflow similar to one from a zirconia master model (mandibular left second premolar-mandibular left second molar). Two polyvinyl siloxane replicas were made for each specimen to measure the marginal and internal fit. Measurement locations were mesial, lingual, buccal, and distal for each abutment. In these locations, the marginal opening (MO), chamfer area (CA), axial wall (AW), and occlusal area (OC) were measured. The data were analyzed with 2-way ANOVA and the Bonferroni post hoc test (α=.05).

RESULTS

Frameworks showed significantly better mean ±standard deviation fit values than complete contour 3-unit FDPs at measurement areas MO (frameworks: 112 ±22 μm, complete contour FDPs: 144 ±37 μm) (P=.013), CA (frameworks: 89 ±12 μm, complete contour FDPs: 110 ±22 μm) (P=.006), and OC (frameworks: 182 ±36 μm, complete contour FDPs: 244 ±64 μm) (P=.008). At the measurement area AW (frameworks: 47 ±7 μm, complete contour FDPs: 50 ±9 μm of each location, no significant difference was observed between frameworks and complete contour FDPs (P=.361).

CONCLUSIONS

Design differences in 3-unit FDPs fabricated from translucent multicolored zirconia influenced the marginal and internal fit. Frameworks had smaller marginal fit than complete contour FDPs for translucent multicolored zirconia.

Accuracy evaluation of 3D printed interim prosthesis fabrication using a CBCT scanning based digital model

OBJECTIVES

This study aimed to evaluate the marginal and internal gaps in 3D-printed interim crowns made from digital models of cone-beam computed tomography (CBCT) conversion data.

MATERIALS AND METHODS

Sixteen polyvinylsiloxane impressions were taken from patients for single crown restorations and were scanned using CBCT. The scanning data were converted to positive Standard Triangulation Language (STL) files using custom-developed software. The fabricated stone models were scanned with an intraoral optical scanner (IOS) to compare the surface accuracy with the STL data obtained by CBCT. The converted STL files were utilized to fabricate interim crowns with a photopolymer using a digital light-processing 3D printer. The replica method was used to analyze the accuracy. The marginal and internal gaps in the replica specimen of each interim crown were measured with a digital microscope. The Friedman test and Mann-Whitney U test (Wilcoxon-signed rank test) were conducted to compare the measurements of the marginal and internal gaps with a 95% level of confidence.

RESULTS

The root-mean-square values of the CBCT and IOS ranged from 41.00 to 126.60 μm, and the mean was 60.12 μm. The mean values of the marginal, internal, and total gaps were 132.96 (±139.23) μm, 137.86 (±103.09) μm, and 135.68 (±120.30) μm, respectively. There were no statistically significant differences in the marginal or internal gaps between the mesiodistal and buccolingual surfaces, but the marginal area (132.96 μm) and occlusal area (255.88 μm) had significant mean differences.

CONCLUSION

The marginal gap of the fabricated interim crowns based on CBCT STL data was within the acceptable range of clinical success. Through ongoing developments of high-resolution CBCT and the digital model conversion technique, CBCT might be an alternative method to acquire digital models for interim crown fabrication.

Comparison of three-dimensional digital technique with two-dimensional replica method for measuring marginal and internal fit of full coverage restorations

PURPOSE

This study compared digital (reference point matching) and replica methods for measuring marginal and internal fit of full coverage restorations.

MATERIALS AND METHODS

A maxillary left first molar typodent was fixed on to an aluminum base and prepared to receive all-ceramic full coverage restoration. The model was scanned with an intraoral scanner (CEREC Omnicam, Sirona, York, PA, USA). Twelve crowns were fabricated from lithium disilicate blocks (IPS emax CAD, Ivoclar Vivadent) and then crystalized. Marginal and internal fit of each restoration was measured by two examiners using replica and a new digital three-dimensional technique. Reliability between the two methods and two examiners was assessed by correlation and Cronbach's Alpha coefficient (P<.05). A Bland-Altman assessment for agreement was used to compare the two methods.

RESULTS

Bland-Altman assessment showed that the mean of difference for marginal, absolute marginal, and axial gap was respectively -1.04 µm, -41.9 µm, and -29.53 µm with limit of agreement (LOA) between -37.26 to 35.18 µm for marginal, -105.85 to 22.05 µm for absolute marginal and -80.52 to 22.02 µm for axial gap. Positive correlation for repeatability (P<.05) in determining marginal and internal gaps by the two examiners in both techniques was revealed. Reliability of both techniques in all sites of measurements was at least good (0.8 ≤ α < 0.9).

CONCLUSION

Both measuring techniques appeared highly reliable for evaluating fit of fixed dental restorations, while reference point matching provided higher values in axial and absolute marginal gap assessment.

Evaluation of Marginal and Internal Fit of Presintered Co-Cr and Zirconia Three-Unit Fixed Dental Prosthesis Compared to Cast Co-Cr

PURPOSE

The precision of soft metal processing technologies is poorly documented. This study compared marginal and internal fit of presintered cobalt-chromium (Co-Cr) and zirconia three-unit fixed dental prostheses (FDPs) to cast Co-Cr.

MATERIALS AND METHODS

Three-unit FDPs were prepared on metal dies (N = 60) from typodont preparations of the maxillary right first premolar and molar. A standardized preparation of a metal-ceramic restoration was done on abutment teeth. The dies (N = 60) were scanned and divided into three groups (n = 20/group) to receive the FDP made of presintered Co-Cr (Ceramill Si), presintered zirconia (Ceramill Zi), and cast Co-Cr (Girobond NB). Each framework was seated on its specific cast. A replica technique was used for marginal and internal discrepancies measurements in mesiodistal and buccolingual planes. Data were analyzed using the Levene test, t-test, and analysis of variance (α = 0.05).

RESULTS

When the overall mean discrepancy values were compared in the mesiodistal plane, a significant difference was found between Ceramill Sintron and Ceramill Zi groups (p = 0.026). No significant difference was detected between Girobond NB and Ceramill Sintron groups and between Girobond NB and Ceramill Zi groups (p = 0.537 and p = 0.569, respectively). In the buccolingual plane, there was no significant difference in the overall mean discrepancy between the three groups: CS/CZ (p = 1.000), GI/CS (p = 0.51), and GI/CZ (p = 0.87). Significant differences at several measurement points were found at the inter or intramaterial level. The increase in discrepancy values between marginal and occlusal measurements was evident for the three groups.

CONCLUSIONS

Presintered three-unit FDPs fabricated from zirconia and Co-Cr exhibited internal and marginal discrepancy values similar to cast Co-Cr. A significant difference was reported between CS and CZ in mesiodistal planes. The axial and marginal differences in values for the three tested groups were below or around the 120 µm clinically acceptable threshold except for the occlusal area. When comparing first premolar to first molar, the internal and marginal discrepancies were similar with no apparent distortion of the framework after the sintering process.

Marginal and internal fit of three-unit zirconia fixed dental prostheses: Effects of prosthesis design, cement space, and zirconia type

PURPOSE

The purpose of this study was to compare the marginal and internal fit of three-unit fixed dental prostheses (FDPs) fabricated using CAD/CAM with two designs, two cement space (CS), and two zirconia types.

METHODS

A master model with two zirconia abutments and a missing tooth was scanned with an intraoral scanner. FDPs were fabricated with two designs (Full contour: FC, Framework: FW), two zirconia types (multi-layer: L, single-layer: W), and two CS values (30 and 45 μm for L and 30 μm for W). There were six experimental groups. The fit of the FDPs was evaluated using the replica method. The space between an abutment and the FDPs in the marginal (MO), chamfer (CH), axial (AX), and occlusal (OC) areas was measured under an optical microscope and the data was statistically analyzed using three-way ANOVA and Bonferroni test (p < 0.05).

RESULTS

FW-l-45 μm showed a significantly smaller space than those for the FC in MO (p = 0.011), CH (p = 0.001) and AXE (p = 0.003). FW-l-30 μm showed a significantly smaller space than that for the 45 µm in AXE (p = 0.000) and OC (p = 0.016). FW-W-30 µm showed a significantly smaller space than that for the L in MO (p = 0.000), CH (p = 0.000), AXE (p = 0.000), and OC (p = 0.002).

CONCLUSIONS

The design and CS of the FDPs affected the fit. FDPs with single-layer zirconia showed better fit than that obtained with multi-layer zirconia.

Analysis of correlation between optical and microtomography measurements of cementation space in CAD-CAM ceramic crowns

STATEMENT OF PROBLEM

Identical computer-aided design (CAD) parameters may be used to mill a variety of ceramic materials for computer-aided design and computer-aided manufacture (CAD-CAM) crowns. Whether milled crown spacing matches the designed parameters when more than a single evaluation method is applied is unknown.

PURPOSE

The purpose of this in vitro study was to correlate the stereomicroscope and the microcomputer tomography (μCT) 2-dimensional analysis of the cementation space with the replica technique in assessing 3 different ceramic materials.

MATERIAL AND METHODS

The specimens were milled in lithium disilicate, resin nanoceramic, and zirconia (n=30). The cement space was measured at the marginal, axial, and occlusal regions. One hundred twenty measurements of each material were used to correlate the methodologies. Data were statistically evaluated with 2-way repeated measures ANOVA and the Tukey test (α=.05). The Pearson correlation coefficient was used for each region for both methodologies (μCT and optical microscopy) separately.

RESULTS

For the μCT analysis, no differences were observed (P>.05) among the materials, but the axial region showed a positive correlation with the marginal (r=0.957) and occlusal regions (r=0.349); the same was observed between the occlusal and marginal regions (r=0.338). However, for stereomicroscope evaluation, resin nanoceramic and zirconia present similar cementation space (P=960), both being different from lithium disilicate (P<.05). The marginal region presented a positive correlation with axial (r=0.149) and occlusal regions (r=0.344), but the axial region showed negative correlation with the occlusal surface (r=-0.205).

CONCLUSIONS

The measurements of the scanned replicas were accurate when thinner sections were under measurement. Although the same space parameters were set in the CAD software program, definitive internal dimensions varied among the milled crowns.

Influence of speed sintering on the fit and fracture strength of 3-unit monolithic zirconia fixed partial dentures

STATEMENT OF PROBLEM

Speed sintering has been introduced to enable single-visit monolithic zirconia prostheses. However, the fit and fracture load of zirconia 3-unit monolithic fixed partial dentures (FPDs) after speed sintering are unknown.

PURPOSE

The purpose of this in vitro study was to test the properties of zirconia 3-unit monolithic FPDs after speed sintering and to compare the properties with conventional sintering.

MATERIAL AND METHODS

A calibrated operator digitized an in vitro model with a complete coverage preparation of a maxillary right second premolar and second molar (n=12) by using the CEREC AC Omnicam (Dentsply Sirona) scanner. Twelve zirconia FPDs were designed (CEREC SW 4.1.1), and for each data set (n=12), 1 FPD was designed and milled 4 times (MCXL Premium; CEREC Zirconia; Dentsply Sirona), resulting in 4 identical monolithic FPDs (N=48). The FPDs were divided into 2 groups according to the sintering procedure (n=24): speed sintering (group S) by using the SpeedFire (Dentsply Sirona) and the conventional sintering (group C) by using the inFire HTC speed (Dentsply Sirona). All the FPDs were glazed by using glaze-spray and fired according to the sintering group. The SpeedFire (Dentsply Sirona) was used for group S, and the VACUMAT 6000M (VITA Zahnfabrik) was used for group C. The fit of the FPDs was evaluated with the replica technique by using polyvinyl siloxane and analyzed according to the measurement areas: marginal gap, chamfer area, axial wall, and occlusal area. Subsequently, groups S and C were further subdivided, and 12 specimens per group underwent artificial aging by thermomechanical loading in a mastication machine (50 N for 1.2×10⁶ times at a frequency of 1.7 Hz and a thermal change in distilled water from 5 °C to 50 °C every 120 seconds), resulting in additional subgroups: group SA and group CA. For all the FPDs (groups S, C, SA, and CA), a fracture load measurement was conducted. The Kolmogorov-Smirnov test was used to examine the values of the fit and fracture load for normal distribution. The Mann-Whitney U test for the fit and a 2-way ANOVA for the fracture load were used to detect the differences among the groups (α=.05).

RESULTS

Group S showed a better marginal (P=.018) and occlusal (P<.001) fit than group C. For the fracture load values, no significant difference was found because of the sintering procedure (P=.070) or the interaction of the sintering procedure and artificial aging (P=.484). Artificial aging showed an impact (P=.024) with significantly lower values after aging.

CONCLUSIONS

Speed-sintered FPDs had equal and better values for the fit and fracture load than conventional sintering.

Digital versus conventional impressions for full-coverage restorations: A systematic review and meta-analysis

BACKGROUND

The primary objective of this systematic review was to investigate the survival of full-coverage restorations fabricated by using digital impressions (DIs) versus that of those fabricated by using conventional impressions. The authors also compared secondary outcomes of marginal and internal fit and occlusal and interproximal contacts.

TYPES OF STUDIES REVIEWED

The authors conducted a systematic literature search in multiple databases to identify clinical trials with no restrictions by publication type, date, or language. The authors assessed study-level risk of bias and outcome-level strength of evidence. The authors performed a meta-analysis by using a random-effects model.

RESULTS

Ten studies met the inclusion criteria. The authors identified no studies in which the investigators compared the impression techniques with respect to survival of full-coverage restorations. Mean differences for marginal gap and internal gap were -9.0 micrometers (95% confidence interval, -18.9 to 0.9) and -15.6 μm (95% confidence interval, -42.6 to 11.4), respectively. Studies assessing internal gap were substantially heterogeneous (I² = 72%; P = .003).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Research is lacking to draw robust conclusions about the relative benefits of DIs in terms of restoration survival. Low-quality evidence for marginal fit and internal fit suggested similar performance for both techniques. Evidence quality for interproximal contact and occlusal contact was very low and insufficient to draw any conclusions regarding how the impression techniques compared. Given the uncertainty of the evidence, results should be interpreted with caution. With increasing popularity and adoption of digital scanners by dentists, pragmatic practice-based trials involving standardized, patient-centered outcomes may improve confidence in the comparative effectiveness of DIs.

Reproducibility of different coping arrangements fabricated by dental micro-stereolithography: Evaluation of marginal and internal gaps in metal copings

Background/purpose

To evaluate the reproducibility of the marginal and internal gaps of metal copings fabricated using dental micro-stereolithography (μ-SLA), which is an additive manufacturing system.

Materials and methods

A study cast of abutment tooth 46 was made from type-IV dental stone and was scanned to create a standard triangulation language file. Arrays of one (ORM), three (TRM), and six (SRM) resin copings were then fabricated on the μ-SLA build platform using investment, burnout, and casting (n = 12). The marginal and internal gaps of these metal copings were measured using a silicone-replica technique with a digital microscope (×160). The data obtained were analyzed using a non-parametric Kruskal–Wallis H test, a post-hoc Mann–Whitney U test, and a Bonferroni correction.

Results

The mean and standard deviation of the marginal gap for each group were measured and found to be 81.1 and 53.2 μm, 68.3 and 44.8 μm, and 90.3 and 57.7 μm for ORM, TRM, and SRM, respectively. There were no statistical differences in the marginal gaps of the three groups (p > 0.05).

Conclusion

The marginal and internal gap of ORM, TRM and SRM groups were considered clinically acceptable.

Accuracy of crowns based on digital intraoral scanning compared to conventional impression-a split-mouth randomised clinical study

OBJECTIVES

The aim of this prospective in vivo study was to evaluate the accuracy of the marginal and internal fit of crowns based on conventional impression (CI) or intraoral scan (IOS) in a randomised, split-mouth set-up.

MATERIALS AND METHODS

Nineteen patients needing full coverage crowns, fitting a split-mouth design, were provided with two lithium disilicate crowns: one based on a CI and one based on an IOS. The marginal and internal accuracy of the crowns were assessed with the replica technique and clinically using a modified California Dental Association (CDA) quality evaluation system.

RESULTS

At the preparation margin, the median gap was 60 μm for IOS and 78 μm for CI. For the other points, the median gap ranged from 91 to 159 μm for IOS and 109 to 181 μm for CI. The accuracy of the IOS was statistically significantly better at all point except at the cusp tip. All crowns where rated R or S at both the 6- and 12-month follow-up appointments. The results for the clinical evaluation with CDA for marginal integrity showed no statistically significant difference between the two impression methods at both the 6- and 12-month evaluations.

CONCLUSIONS

Crowns based on IOS show statistically significantly better marginal and internal adaptation before cementation compared to conventional impression. However, the clinical evaluation showed similar marginal adaptation.

CLINICAL RELEVANCE

Crowns based on a fully digital workflow can provide clinically acceptable marginal adaptation, comparable to crowns based on CI.

Evaluation of dimensional accuracy of dental bridges manufactured with conventional casting technique and CAD/CAM system with Ceramill Sintron blocks using CMM

Background. Recently, non-presintered chromium-cobalt (Cr-Co) blocks with the commercial name of Ceramill Sintron were introduced to the market. However, comprehensive studies on the dimensional accuracy and fit of multi-unit frameworks made of these blocks using the coordinate measuring machine (CMM) are lacking. This study aimed to assess and compare the dimensional changes and fit of conventional casting and milled frameworks using Ceramill Sintron.

Methods. A metal model was designed and scanned and 5-unit frameworks were fabricated using two techniques: (I) the conventional casting method (n=20): the wax model was designed, milled in the CAD/CAM machine, flasked and invested; (II) the milling method using Ceramill Sintron blocks (n=20): the wax patterns of group 1 were used; Ceramill Sintron blocks were milled and sintered. Measurements were made on the original reference model and the fabricated frameworks using the CMM in all the three spatial dimensions, and dimensional changes were recorded in a checklist. Data were analyzed with descriptive statistics, and the two groups were compared using one-way ANOVA and Tukey test (α=0.05).

Results. The fabricated frameworks in both groups showed significant dimensional changes in all the three dimensions. Comparison of dimensional changes between the two groups revealed no significant differences (P>0.05) except for transverse changes (arch) that were significantly greater in Ceramill Sintron frameworks (P<0.05).

Conclusion. The two manufacturing processes were the same regarding dimensional changes and the magnitude of marginal gaps and both processes resulted in significant dimensional changes in frameworks. Ceramill Sintron frameworks showed significantly greater transverse changes than the conventional frameworks.

Can lithium disilicate ceramic crowns be fabricated on the basis of CBCT data?

OBJECTIVES

Evaluating the fit of CAD/CAM lithium disilicate ceramic crowns fabricated on basis of direct and indirect digitalization of impressions by CBCT or of dental casts.

MATERIAL AND METHODS

A metal model with a molar chamfer preparation was digitized (n = 12 per group) in four ways: IOS-direct digitalization using an Intra-Oral scanner (CS3600), cone-beam computed tomography scan (CBCT 1)-indirect digitalization of impression (CBCT-CS9300), CBCT 2-indirect digitalization of impression (CBCT-CS8100), and Extra-Oral scanner (EOS)-indirect digitalization of gypsum-cast (CeramillMap400). Accuracy of 3D datasets was evaluated in relation to a reference dataset by best-fit superimposition. Marginal fit of lithium disilicate crowns after grinding was evaluated by replica technique. Significant differences were detected for 3D accuracy by Mann-Whitney U and for fit of crowns by One-way ANOVA followed by Scheffe's post hoc (p = 0.05).

RESULTS

3D analysis revealed mean positive and negative deviations for the groups IOS (- 0.011 ± 0.007 mm/0.010 ± 0.003 mm), CBCT 1 (- 0.046 ± 0.008 mm/0.093 ± 0.004 mm), CBCT 2 (- 0.049 ± 0.030 mm/0.072 ± 0.015 mm), and EOS (- 0.023 ± 0.007 mm/0.028 ± 0.007 mm). Marginal fit presented the results IOS (0.056 ± 0.022 mm), CBCT 1 (0.096 ± 0.034 mm), CBCT 2 (0.068 ± 0,026 mm), and EOS (0.051 ± 0.017 mm).

CONCLUSIONS

The marginal fit of EOS and IOS, IOS and CBCT 2, and CBCT 2 and CBCT 1 showed statistical differences. The marginal fit of CBCT 1 and CBCT 2 is within the range of clinical acceptance; however, it is significant inferior to EOS and IOS.

CLINICAL RELEVANCE

The use of a CBCT enables clinicians to digitize conventional impressions. Despite presenting results within clinical acceptable levels, the CBCT base method seems to be inferior to Intra-Oral scans or to scanning gypsum models regarding the resulting accuracy and fit.

Comparison of the Fit of Lithium Disilicate Crowns made from Conventional, Digital, or Conventional/Digital Techniques

PURPOSE

To evaluate the fit of single crowns fabricated using conventional, digital, or cast digitization methods.

MATERIALS AND METHODS

One subject with a peg-shaped maxillary lateral incisor was selected in this study. Tooth preparation for an all-ceramic crown was performed and 10 conventional poly(vinyl siloxane) impressions, and 10 digital impressions using an intraoral scanner were made. Each working cast was scanned using a laboratory scanner and an intraoral scanner. Four groups were tested Group 1: conventional impressions. Group 2: cast laboratory scans. Group 3: cast scans using intraoral scanner. Group 4: direct intraoral scans. For group 1, heat-pressed glass ceramic crowns (IPS e.max Press) were fabricated using casts produced from the conventional impressions. For groups 2-4, crowns were milled using ceramic blocks (IPS e.max CAD). Ten crowns were fabricated for each group. Marginal and internal gaps were measured using a replica technique. Replicas were sectioned mesiodistally and buccolingually and were observed under a stereomicroscope. Three measurements were selected for each cut: occlusal, axial, and marginal. Statistical analysis was performed using two-way ANOVA and Tukey HSD tests.

RESULTS

For each replica, 6 measurements were made for the mesiodistal and the same for the buccolingual cuts, producing 12 measurement points per crown (4 measurements for marginal, 4 for axial, 4 for occlusal), 120 measurements for each group (40 measurements for marginal, 40 for axial, 40 for occlusal), and 480 measurements in total. Two-way ANOVA revealed location to be a significant factor (p = 0.001). No significant differences among groups (p = 0.456), and no interactions between groups and locations (p = 0.221) were found. Means for the occlusal site were significantly larger than other sites in most group combinations, while the difference between the marginal and axial sites was not significant. No significant differences among groups were found for each measurement. The marginal gaps ranged from 125.46 ± 25.39 μm for group 3 to 135.59 ± 24.07 μm for group 4. The smallest axial mean was in group 1 (98.10 ± 18.77 μm), and the largest was 127.25 ± 19.79 μm in group 4. The smallest occlusal mean was in group 2 (166.53 ± 36.51 μm), and the largest occlusal mean was in group 3 (203.32 ± 80.24 μm).

CONCLUSIONS

Ceramic crowns, which were made using all-digital approach or cast digitization by a laboratory or intraoral scanner had comparable fit to those produced by conventional approach.

Effect of number of pontics and impression technique on the accuracy of four-unit monolithic zirconia fixed dental prostheses

STATEMENT OF PROBLEM

Because of their relatively small scanning area, intraoral scanners may result in less accurate fixed dental prostheses (FDPs) than do laboratory scanners.

PURPOSE

The purpose of this in vitro study was to evaluate the accuracy of monolithic zirconia FDPs with different numbers of pontics fabricated with different impression techniques.

MATERIAL AND METHODS

The mandibular right premolars and molars of an acrylic resin model were prepared to receive 4-unit FDPs. Three master models were fabricated with epoxy resin: model NP, no pontic; model 1P, 1 pontic; and model 2P, 2 pontics. Each master model was scanned by using direct (DD) and indirect digitalization (ID). Four-unit monolithic zirconia FDPs were fabricated and divided into 3 groups (groups NP, 1P, and 2P) and then subdivided according to the digitalization technique (group DD and ID; n=10). The FDPs were also evaluated based on the presence (Po) or absence (NPo) of an adjacent pontic. The marginal, axial, and occlusal gap widths of each FDP were measured, and statistical analyses were performed to evaluate and compare the amount of gap present (α=.05).

RESULTS

For direct digitalization, group 2P had significantly greater marginal (69.4 μm versus 60.9 μm or 62.3 μm; P<.001) and axial gap widths (127.1 μm versus 108.9 μm or 110.4 μm; P<.001) than group NP or 1P. Group DD resulted in significantly smaller gaps compared with group ID at marginal (64.8 μm versus 73.6 μm), axial (114.8 μm versus 124.3 μm), and occlusal (172.6 μm versus 184.1 μm) measurement locations (P<.001). Greater marginal and axial gaps were noted in group Po than NPo (P<.001).

CONCLUSIONS

The length of the edentulous area significantly influenced the extent of the marginal and internal gap with the use of direct digitalization. Direct digitalization resulted in significantly smaller gap widths in all measurement areas than indirect digitalization; however, the mean differences were less than 12 μm, which is considered clinically insignificant. The presence of an adjacent pontic had a significant effect on the adjacent marginal and axial gap widths.

Marginal and internal fit of pre-sintered Co-Cr and zirconia 3-unit fixed dental prostheses as measured using microcomputed tomography

STATEMENT OF PROBLEM

Limited information is available on the precision of new metal processing technologies.

PURPOSE

The purpose of this in vitro study was to evaluate the marginal and internal fit of pre-sintered cobalt-chromium (Co-Cr) and zirconia 3-unit fixed dental prostheses using x-ray microcomputed tomography.

MATERIAL AND METHODS

Three-unit fixed dental prostheses were prepared on metal dies (N=12) using a typodont model from the maxillary first premolar to the first molar. A standardized preparation with a 1.2-mm chamfer (360 degrees) and a 2-mm occlusal reduction was prepared on abutment teeth. The dies were scanned and divided into 2 groups to receive the fixed dental prostheses (n=6) made of pre-sintered Co-Cr and pre-sintered zirconia. Each framework was seated on its cast, and marginal and internal discrepancies were measured at 9 points, starting from the most distal point from the pontic for the maxillary first premolar and the first molar (points 1-4, mesial; point 5, occlusal; points 6-9, distal) of each abutment tooth using microcomputed tomography. The data were analyzed using the Levene test, t test, and ANOVA (α=.05).

RESULTS

When overall mean discrepancy values were compared, no significant difference was observed between pre-sintered Co-Cr and pre-sintered zirconia (P=.085). Discrepancy values for points 1, 2, and 3 were significantly different for pre-sintered Co-Cr and pre-sintered zirconia, with the lowest mean values for point 1 and the highest for point 5. On the abutment tooth basis, for the maxillary first premolar and the first molar, a significant difference was found only in points 6 (P<.001) and 8 (P<.003) for both materials. When the discrepancies for the maxillary first premolar were considered for pre-sintered Co-Cr and pre-sintered zirconia, the mean values were significantly different only at points 1 (P<.001), 2 (P=.007), and 3 (P=.003) and were smaller for pre-sintered zirconia. For the tooth the first molar, a significant difference was observed at point 2 (P=.002) and point 3 (P=.008) for both materials, where the mean values were higher for pre-sintered Co-Cr than for pre-sintered zirconia. The pairwise comparison between points showed a significant difference between measurement points within each material (P<.05). The increase in values between points 1 and 5 was evident for both pre-sintered Co-Cr and pre-sintered zirconia materials.

CONCLUSIONS

Three-unit fixed dental prostheses made of pre-sintered Co-Cr or zirconia showed similar marginal and internal discrepancy values, with the highest discrepancy values at the occlusal region in both the first premolar and first molar.

Evaluation of adaptation of ceramic inlays using optical coherence tomography and replica technique

Optical coherence tomography (OCT) has generally been used as a nondestructive technique to evaluate integrities of composite restorations. We investigated marginal and internal adaptations of ceramic inlay restorations with OCT and compared them to results with the silicone replica technique. Round-shaped class I cavities were prepared on 16 human maxillary first premolar teeth. Ceramic inlays were fabricated. Silicone replicas from inlays were obtained and sectioned to measure marginal and internal adaptations with a stereomicroscope (Leica Dfc 295, Bensheim, Germany). Inlays were cemented on respective teeth. Marginal and internal adaptations were then measured with the OCT system (Thorlabs, New Jersey, USA) in 200- μm intervals. Replica and OCT measurements were compared with independent samples t-tests. A paired t-test was used to evaluate the marginal and internal adaptations of each group (p < 0.05). Marginal and internal adaptations were 100.97 ± 31.36 and 113.94 ± 39.75 μm, respectively, using the replica technique and 28.97 ± 17.86 and 97.87 ± 21.83 μm, respectively, using OCT. The differences between the techniques were significant (p = 0.00 and p = 0.01, respectively). On evaluation within the groups, internal adaptation values were found to be significantly higher than the marginal adaptation values for the replica technique (p = 0.00) and OCT (p = 0.00). Therefore, the replica and OCT techniques showed different results, with higher values of marginal and internal adaptation found with the replica technique. Marginal and internal adaptation values of ceramic inlays, whether measured by replica or OCT techniques, were within clinically acceptable limits.

Reliability of light microscopy and a computer-assisted replica measurement technique for evaluating the fit of dental copings

The aim of this in vitro study was to assess the reliability of two measurement systems for evaluating the marginal and internal fit of dental copings.

Effect of manufacturing protocol on the internal fit and marginal discrepancy of metal ceramic and full ceramic dental crowns

The accuracy of internal fit and marginal precision plays important role of clinical quality and success of dental crowns. Complications caused by marginal discrepancies such as caries, gingivitis, hypersensitivity are highlighted in dental literature. Despite marginal fit, internal fit and precision have a significant role in the persistence of full ceramic and metal ceramic crowns. As the technology evolves, it’s questionable which impression and manufacturing method is giving most accurate dental crowns. Therefore, the main purpose of this study is to get some information and data about marginal and internal fitting of dental crowns made by conventional, two-phase impression technique with polyvinyl siloxanes, and using different manufacturing process. Keywords: internal fit, marginal discrepancy, metal ceramic, full ceramic crowns

Evaluation of marginal and internal gap of three-unit metal framework according to subtractive manufacturing and additive manufacturing of CAD/CAM systems

PURPOSE

To evaluate the fit of a three-unit metal framework of fixed dental prostheses made by subtractive and additive manufacturing.

MATERIALS AND METHODS

One master model of metal was fabricated. Twenty silicone impressions were made on the master die, working die of 10 poured with Type 4 stone, and working die of 10 made of scannable stone. Ten three-unit wax frameworks were fabricated by wax-up from Type IV working die. Stereolithography files of 10 three-unit frameworks were obtained using a model scanner and three-dimensional design software on a scannable working die. The three-unit wax framework was fabricated using subtractive manufacturing (SM) by applying the prepared stereolithography file, and the resin framework was fabricated by additive manufacturing (AM); both used metal alloy castings for metal frameworks. Marginal and internal gap were measured using silicone replica technique and digital microscope. Measurement data were analyzed by Kruskal-Wallis H test and Mann-Whitney U-test (α=.05).

RESULTS

The lowest and highest gaps between premolar and molar margins were in the SM group and the AM group, respectively. There was a statistically significant difference in the marginal gap among the 3 groups (P<.001). In the marginal area where pontic was present, the largest gap was 149.39 ± 42.30 µm in the AM group, and the lowest gap was 24.40 ± 11.92 µm in the SM group.

CONCLUSION

Three-unit metal frameworks made by subtractive manufacturing are clinically applicable. However, additive manufacturing requires more research to be applied clinically.

Internal fit of three-unit fixed dental prostheses produced by computer-aided design/computer-aided manufacturing and the lost-wax metal casting technique assessed using the triple-scan protocol

Suboptimal adaptation of fixed dental prostheses (FDPs) can lead to technical and biological complications. It is unclear if the computer-aided design/computer-aided manufacturing (CAD/CAM) technique improves adaptation of FDPs compared with FDPs made using the lost-wax and metal casting technique. Three-unit FDPs were manufactured by CAD/CAM based on digital impression of a typodont model. The FDPs were made from one of five materials: pre-sintered zirconium dioxide; hot isostatic pressed zirconium dioxide; lithium disilicate glass-ceramic; milled cobalt-chromium; and laser-sintered cobalt-chromium. The FDPs made using the lost-wax and metal casting technique were used as reference. The fit of the FDPs was analysed using the triple-scan method. The fit was evaluated for both single abutments and three-unit FDPs. The average cement space varied between 50 μm and 300 μm. Insignificant differences in internal fit were observed between the CAD/CAM-manufactured FDPs, and none of the FPDs had cement spaces that were statistically significantly different from those of the reference FDP. For all FDPs, the cement space at a marginal band 0.5-1.0 mm from the preparation margin was less than 100 μm. The milled cobalt-chromium FDP had the closest fit. The cement space of FDPs produced using the CAD/CAM technique was similar to that of FDPs produced using the conventional lost-wax and metal casting technique.

Marginal Fit Comparison of CAD/CAM Crowns Milled from Two Different Materials

PURPOSE

To evaluate the marginal fit of CAD/CAM copings milled from hybrid ceramic (Vita Enamic) blocks and lithium disilicate (IPS e.max CAD) blocks, and to evaluate the effect of crystallization firing on the marginal fit of lithium disilicate copings.

MATERIALS AND METHODS

A standardized metal die with a 1-mm-wide shoulder finish line was imaged using the CEREC AC Bluecam. The coping was designed using CEREC 3 software. The design was used to fabricate 15 lithium disilicate and 15 hybrid ceramic copings. Design and milling were accomplished by one operator. The copings were seated on the metal die using a pressure clamp with a uniform pressure of 5.5 lbs. A Macroview Microscope (14×) was used for direct viewing of the marginal gap. Four areas were imaged on each coping (buccal, distal, lingual, mesial). Image analysis software was used to measure the marginal gaps in μm at 15 randomly selected points on each of the four surfaces. A total of 60 measurements were made per specimen. For lithium disilicate copings the measurements for marginal gap were made before and after crystallization firing. Data were analyzed using paired t-test and Kruskal-Wallis test.

RESULTS

The overall mean difference in marginal gap between the hybrid ceramic and crystallized lithium disilicate copings was statistically significant (p < 0.01). Greater mean marginal gaps were measured for crystallized lithium disilicate copings. The overall mean difference in marginal gap before and after firing (precrystallized and crystallized lithium disilicate copings) showed an average of 62 μm increase in marginal gap after firing. This difference was also significant (p < 0.01).

CONCLUSIONS

A significant difference exists in the marginal gap discrepancy when comparing hybrid ceramic and lithium disilicate CAD/CAM crowns. Also crystallization firing can result in a significant increase in the marginal gap of lithium disilicate CAD/CAM crowns.

Evaluation of marginal and internal gaps in single and three-unit metal frameworks made by micro-stereolithography

PURPOSE

The purpose of this study is to compare single and three-unit metal frameworks that are produced by micro-stereolithography.

MATERIALS AND METHODS

Silicone impressions of a selected molar and a premolar were used to make master abutments that were scanned into a stereolithography file. The file was processed with computer aided design software to create single and three-unit designs from which resin frameworks were created using micro-stereolithography. These resin frameworks were subjected to investment, burnout, and casting to fabricate single and three-unit metal ones that were measured under a digital microscope by using the silicone replica technique. The measurements were verified by means of the Mann-Whitney U test (α=.05).

RESULTS

The marginal gap was 101.9 ± 53.4 µm for SM group and 104.3 ± 62.9 µm for TUM group. The measurement of non-pontics in a single metal framework was 93.6 ± 43.9 µm, and that of non-pontics in a three-unit metal framework was 64.9 ± 46.5 µm. The dimension of pontics in a single metal framework was 110.2 ± 61.4 µm, and that of pontics in a three-unit metal framework was 143.7 ± 51.8 µm.

CONCLUSION

The marginal gap was smaller for the single metal framework than for the three-unit one, which requires further improvement before it can be used for clinical purposes.

Evaluation of internal fit of interim crown fabricated with CAD/CAM milling and 3D printing system

PURPOSE

This study is to evaluate the internal fit of the crown manufactured by CAD/CAM milling method and 3D printing method.

MATERIALS AND METHODS

The master model was fabricated with stainless steel by using CNC machine and the work model was created from the vinyl-polysiloxane impression. After scanning the working model, the design software is used to design the crown. The saved STL file is used on the CAD/CAM milling method and two types of 3D printing method to produce 10 interim crowns per group. Internal discrepancy measurement uses the silicon replica method and the measured data are analyzed with One-way ANOVA to verify the statistic significance.

RESULTS

The discrepancy means (standard deviation) of the 3 groups are 171.6 (97.4) µm for the crown manufactured by the milling system and 149.1 (65.9) and 91.1 (36.4) µm, respectively, for the crowns manufactured with the two types of 3D printing system. There was a statistically significant difference and the 3D printing system group showed more outstanding value than the milling system group.

CONCLUSION

The marginal and internal fit of the interim restoration has more outstanding 3D printing method than the CAD/CAM milling method. Therefore, the 3D printing method is considered as applicable for not only the interim restoration production, but also in the dental prosthesis production with a higher level of completion.

Comparison and evaluation of marginal and internal gaps in cobalt-chromium alloy copings fabricated using subtractive and additive manufacturing

PURPOSE

To evaluate the marginal and internal gaps of cobalt-chromium (Co-Cr) alloy copings fabricated using subtractive and additive manufacturing.

METHODS

A study model of an abutment tooth 46 was prepared by a 2-step silicone impression with dental stone. Fifteen stereolithography files for Co-Cr alloy copings were compiled using a model scanner and dental CAD software. Using the lost wax (LW), wax block (WB), soft metal block (SMB), microstereolithography (μ-SLA), and selected laser melting (SLM) techniques, 15 Co-Cr alloy copings were fabricated per group. The marginal and internal gaps of these Co-Cr alloy copings were measured using a digital microscope (160×), and the data obtained were analyzed using the non-parametric Kruskal-Wallis H-test and post-hoc Mann-Whitney U-test with Bonferroni correction.

RESULTS

The mean values of the marginal, axial wall, and occlusal gaps were 91.8, 83.4, and 163μm in the LW group; 94.2, 77.5, and 122μm in the WB group; 60.0, 79.4, and 90.8μm in the SMB group; 154, 72.4, and 258μm in the μ-SLA group; and 239, 73.6, and 384μm in the SLM group, respectively. The differences in the marginal and occlusal gaps between the 5 groups were statistically significant (P<.05).

CONCLUSIONS

The marginal gaps of the LW, WB, and SMB groups were within the clinically acceptable limit, but further improvements in the μ-SLA and SLM approaches may be required prior to clinical implementation.

Evaluation of marginal and internal gaps of Ni-Cr and Co-Cr alloy copings manufactured by microstereolithography

PURPOSE

The purpose of this study was to evaluate the marginal and internal gaps of Ni-Cr and Co-Cr copings, fabricated using the dental µ-SLA system.

MATERIALS AND METHODS

Ten study dies were made using a two-step silicone impression with a dental stone (type IV) from the master die of a tooth. Ni-Cr (NC group) and Co-Cr (CC group) alloy copings were designed using a dental scanner, CAD software, resin coping, and casting process. In addition, 10 Ni-Cr alloy copings were manufactured using the lost-wax technique (LW group). The marginal and internal gaps in the 3 groups were measured using a digital microscope (160 ×) with the silicone replica technique, and the obtained data were analyzed using the non-parametric Kruskal-Wallis H test. Post-hoc comparisons were performed using Bonferroni-corrected Mann-Whitney U tests (α=.05).

RESULTS

The mean (±standard deviation) values of the marginal, chamfer, axial wall, and occlusal gaps in the 3 groups were as follows: 81.5±73.8, 98.1±76.1, 87.1±44.8, and 146.8±78.7 µm in the LW group; 76.8±48.0, 141.7±57.1, 80.7±47.5, and 194.69±63.8 µm in the NC group; and 124.2±52.0, 199.5±71.0, 67.1±37.6, and 244.5±58.9 µm in the CC group.

CONCLUSION

The marginal gap in the LW and NC groups were clinically acceptable. Further improvement is needed for CC group to be used clinical practice.

Comparison of digital intraoral scanners by single-image capture system and full-color movie system

BACKGROUND

The use of dental computer-aided design/computer-aided manufacturing (CAD/CAM) restoration is rapidly increasing.

OBJECTIVE

This study was performed to evaluate the marginal and internal cement thickness and the adhesive gap of internal cavities comprising CAD/CAM materials using two digital impression acquisition methods and micro-computed tomography.

METHODS

Images obtained by a single-image acquisition system (Bluecam Ver. 4.0) and a full-color video acquisition system (Omnicam Ver. 4.2) were divided into the BL and OM groups, respectively. Silicone impressions were prepared from an ISO-standard metal mold, and CEREC Stone BC and New Fuji Rock IMP were used to create working models (n=20) in the BL and OM groups (n=10 per group), respectively. Individual inlays were designed in a conventional manner using designated software, and all restorations were prepared using CEREC inLab MC XL. These were assembled with the corresponding working models used for measurement, and the level of fit was examined by three-dimensional analysis based on micro-computed tomography.

RESULTS

Significant differences in the marginal and internal cement thickness and adhesive gap spacing were found between the OM and BL groups.

CONCLUSIONS

The full-color movie capture system appears to be a more optimal restoration system than the single-image capture system.

Evaluation of Two Protocols to Measure the Accuracy of Fixed Dental Prostheses: An In Vitro Study

PURPOSE

The aim of this in vitro study was to compare two measurement protocols of the internal and marginal fit of three-unit zirconia fixed dental prostheses (FDPs).

MATERIALS AND METHODS

Forty-four FDPs were fabricated for standardized dies by two laboratory CAD/CAM systems: Cercon (n = 22) and Ceramill (n = 22). The fitting was tested using a replica technique (RT = technique 1) with a light-body silicone stabilized with heavy-body material. After producing the replicas, cross-sections were made in the buccolingual and mesiodistal directions. FDPs were cemented on definitive dies, embedded, and sectioned (CST = technique 2). The marginal and internal fits were measured under an optical microscope at 50x magnification with a special software program. Data evaluation was performed according to prior studies at a level of significance of 5%.

RESULTS

The mean internal gap width was 51 ± 36 μm for the RT and 52 ± 35 μm for the cross-section technique (CST) (p = 0.74). The mean marginal gap width was 27 ± 18 μm for RT and 30 ± 19 μm for CST (p = 0.19). Statistical tests showed no significant differences (p > 0.05).

CONCLUSIONS

Both techniques can be used for fit evaluation; however, the noninvasive RT is suitable for clinical use.

Comparison of the fit of cast gold crowns fabricated from the digital and the conventional impression techniques

PURPOSE

The purpose of this study was to compare the fit of cast gold crowns fabricated from the conventional and the digital impression technique.

MATERIALS AND METHODS

Artificial tooth in a master model and abutment teeth in ten patients were restored with cast gold crowns fabricated from the digital and the conventional impression technique. The forty silicone replicas were cut in three sections; each section was evaluated in nine points. The measurement was carried out by using a measuring microscope and I-Soultion. Data from the silicone replica were analyzed and all tests were performed with α-level of 0.05.

RESULTS

1. The average gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly. 2. In marginal and internal axial gap of cast gold crowns, no statistical differences were found between the two impression techniques. 3. The internal occlusal gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly.

CONCLUSION

Both prostheses presented clinically acceptable results with comparing the fit. The prostheses fabricated from the digital impression technique showed more gaps, in respect of occlusal surface.

Internal fit of single crowns produced by CAD-CAM and lost-wax metal casting technique assessed by the triple-scan protocol

STATEMENT OF PROBLEM

Whether single crowns produced by computer-aided design and computer-aided manufacturing (CAD-CAM) have an internal fit comparable to crowns made by lost-wax metal casting technique is unknown.

PURPOSE

The purpose of this in vitro study was to compare the internal fit of single crowns produced with the lost-wax and metal casting technique with that of single crowns produced with the CAD-CAM technique.

MATERIAL AND METHODS

The internal fit of 5 groups of single crowns produced with the CAD-CAM technique was compared with that of single crowns produced in cobalt-chromium with the conventional lost-wax and metal casting technique. Comparison was performed using the triple-scan protocol; scans of the master model, the crown on the master model, and the intaglio of the crown were superimposed and analyzed with computer software. The 5 groups were milled presintered zirconia, milled hot isostatic pressed zirconia, milled lithium disilicate, milled cobalt-chromium, and laser-sintered cobalt-chromium.

RESULTS

The cement space in both the mesiodistal and buccopalatal directions was statistically smaller (P<.05) for crowns made by the conventional lost-wax and metal casting technique compared with that of crowns produced by the CAD-CAM technique.

CONCLUSIONS

Single crowns made using the conventional lost-wax and metal casting technique have better internal fit than crowns produced using the CAD-CAM technique.

Reproducibility of different arrangement of resin copings by dental microstereolithography: Evaluating the marginal discrepancy of resin copings

STATEMENT OF PROBLEM

Microstereolithography (μ-SLA), a form of additive manufacturing, can produce one or more platforms of resin copings. However, no evaluation has been made of the variation in marginal discrepancy using this method, even though this is an important factor for a successful restoration.

PURPOSE

The purpose of this in vitro study was to evaluate the reproducibility and marginal discrepancy of resin copings fabricated using dental μ-SLA.

MATERIAL AND METHODS

A master die of a mandibular right first molar tooth was made from Type IV stone and scanned to produce a stereolithography file. Resin copings were then fabricated using μ-SLA additive manufacturing by repeating 1, 3, or 6 arrays to give a total number of 18. The marginal discrepancies of these resin copings were measured using digital microscopy (at ×160 magnification), and the data obtained were analyzed using a nonparametric Kruskal-Wallis H test, post hoc Mann-Whitney U-test, and Bonferroni correction.

RESULTS

The mean ±SD total marginal discrepancies of 1, 3, and 6 arrays were found to be 72.2 ±39.1 μm, 61.2 ±37.3 μm, and 92.5 ±54.1 μm. Statistically significant differences were found among the compared groups (P<.05).

CONCLUSIONS

Based on the marginal discrepancy, μ-SLA of additive manufacturing is more precise when 3 arrays are used than when 1 or 6 arrays are used on a single build platform. Because the fit is affected by the number of copings fabricated, further research of multiple resin copings is required.