Positional accuracy of a single implant analog in additively manufactured casts in biobased model resin.

OBJECTIVES: To evaluate the positional accuracy of implant analogs in biobased model resin by comparing them to that of implant analogs in model resin casts and conventional analogs in dental stone casts. METHODS: Polyvinylsiloxane impressions of a partially edentulous mandibular model with a single implant were made and poured in type IV dental stone. The same model was also digitized with an intraoral scanner and additively manufactured implant casts were fabricated in biobased model resin (FotoDent biobased model) and model resin (FotoDent model 2 beige-opaque) (n = 8). All casts and the model were digitized with a laboratory scanner, and the scan files were imported into a 3-dimensional analysis software (Geomagic Control X). The linear deviations of 2 standardized points on the scan body used during digitization were automatically calculated on x-, y-, and z-axes. Average deviations were used to define precision, and 1-way analysis of variance and Tukey HSD tests were used for statistical analyses (α = 0.05). RESULTS: Biobased model resin led to higher deviations than dental stone (all axes, P ≤ 0.031) and model resin (y-axis, P = 0.015). Biobased model resin resulted in the lowest precision of implant analog position (P ≤ 0.049). The difference in the positional accuracy of implant analogs of model resin and stone casts was nonsignificant (P ≥ 0.196). CONCLUSIONS: Implant analogs in biobased model resin casts mostly had lower positional accuracy, whereas those in model resin and stone casts had similar positional accuracy. Regardless of the material, analogs deviated more towards mesial, while buccal deviations in additively manufactured casts and lingual deviations in stone casts were more prominent.

Dimensional Stability of Additively Manufactured Dentate Maxillary Diagnostic Casts in Biobased Model Resin.

This study aimed to evaluate the dimensional stability of maxillary diagnostic casts fabricated from a biobased model resin, which consists of 50% renewable raw materials for sustainable production, a model resin, and stone, over one month. A master maxillary stone cast was digitized with a laboratory scanner to generate a reference file. This master cast was also scanned with an intraoral scanner to additively manufacture casts with a biobased model resin (BAM) and a model resin (AM). Polyvinylsiloxane impressions of the master cast were also made and poured in type III stone (CV) (n = 8). The same laboratory scanner was used to digitize each model one day (T0), 1 week (T1), 2 weeks (T2), 3 weeks (T3), and 4 weeks (T4) after fabrication. Deviations from the reference file were calculated with an analysis software and analyzed with generalized linear model analysis (α = 0.05). The interaction between the material and the time point affected measured deviations (p < 0.001). Regardless of the time point, CV had the lowest and AM had the highest deviations (p < 0.001). BAM mostly had lower deviations at T0 and mostly had higher deviations at T4 (p ≤ 0.011). AM had the highest deviations at T4 and then at T3, whereas it had the lowest deviations at T0 (p ≤ 0.002). The measured deviations of CV increased after each time point (p < 0.001). BAM casts had deviations within the previously reported clinically acceptable thresholds over one month and had acceptable dimensional stability. Therefore, tested biobased resin may be a viable alternative for the sustainable manufacturing of maxillary diagnostic casts that are to be used clinically.

Fracture resistance of additively or subtractively manufactured resin-based definitive crowns: Effect of restorative material, resin cement, and cyclic loading.

OBJECTIVE: To evaluate how restorative material, resin cement, and cyclic loading affect the fracture resistance of resin-based crowns fabricated by using additive or subtractive manufacturing. METHODS: A right first molar crown standard tessellation language (STL) file was used to fabricate 120 crowns from one subtractively manufactured polymer-infiltrated ceramic network (SM) and two additively manufactured resin composites (AM-B and AM-S) (N = 40). These crowns were randomly divided into 4 groups within each material according to the dual-polymerizing resin cement to be used (RX and PN) and the aging condition (n = 10). After cementation, the crowns without cyclic loading were subjected to fracture testing, while the others were first cyclically loaded (1.7 Hz, 1.2 million cycles, and 49-N load) and then subjected to fracture testing. Data were analyzed with generalized linear model analysis (α = .05). RESULTS: Fracture resistance of the crowns was affected by material, resin cement, and cyclic loading (P ≤ .030). However, none of the interactions significantly affected fracture resistance of tested crowns (P ≥ .140). Among tested materials, SM had the highest fracture resistance, whereas AM-B had the lowest (P ≤ .025). RX led to higher fracture resistance, and cyclic loading decreased the fracture resistance (P ≤ .026). SIGNIFICANCE: Tested materials can be considered reliable in terms of fracture resistance in short- or mid-term (5 years of intraoral simulation) when used for single molar crowns with 2 mm occlusal thickness. In the long term, polymer-infiltrated ceramic network crowns cemented with RelyX Universal may provide promising results and be less prone to complications considering higher fracture resistance values obtained.

Fatigue behavior of implant-supported cantilevered prostheses in recently introduced CAD-CAM polymers: An in vitro study.

STATEMENT OF PROBLEM: Cantilevered complete arch implant-supported prostheses are commonly fabricated from zirconia and more recently from strength gradient zirconia. Different polymer-based materials indicated for definitive fixed prostheses that could be used with additive or subtractive manufacturing have also been marketed recently. However, knowledge on the long-term fatigue behavior of cantilevered implant-supported prostheses made from these polymer-based materials and strength gradient zirconia is lacking. PURPOSE: The purpose of this in vitro study was to evaluate the fatigue behavior of implant-supported cantilevered prostheses of recently introduced computer-aided design and computer-aided manufacturing polymers and zirconia. MATERIAL AND METHODS: A master standard tessellation language file of a 9×11×20-mm specimen with a titanium base (Ti-base) space that represented an implant-supported cantilevered prosthesis was used to fabricate specimens from additively manufactured interim resin (AM), polymethyl methacrylate (SM-PM), nanographene-reinforced polymethyl methacrylate (SM-GR), high-impact polymer composite resin (SM-CR), and strength gradient zirconia (SM-ZR) (n=10). Each specimen was prepared by following the respective manufacturer's recommendations, and Ti-base abutments were cemented with an autopolymerizing luting composite resin. After cementation, the specimens were mounted in a mastication simulator and subjected to 1.2 million loading cycles under 100 N at 1.5 Hz; surviving specimens were subjected to another 1.2 million loading cycles under 200 N at 1.5 Hz. The load was applied to the cantilever extension, 12-mm from the clamp of the mastication simulator. The Kaplan-Meier survival analysis and Cox proportional hazards model were used to evaluate the data (α=.05). RESULTS: Significant differences in survival rate and hazard ratio were observed among materials (P<.001). Among tested materials, SM-ZR had the highest and AM had the lowest survival rate (P≤.031). All materials had a significantly higher hazard ratio than SM-ZR (P≤.011) in the increasing order of SM-GR, SM-PM, SM-CR, and AM. CONCLUSIONS: SM-ZR had the highest survival rate with no failed specimens. Even though most of the tested polymer-based materials failed during cyclic loading, these failures were commonly observed during the second 1.2 million loading cycles with 200 N. All materials had a higher hazard ratio than SM-ZR.

Effect of material and antagonist type on the wear of occlusal devices with different compositions fabricated by using conventional, additive, and subtractive manufacturing.

STATEMENT OF PROBLEM: Additive (AM) and subtractive (SM) manufacturing have become popular for fabricating occlusal devices with materials of different chemical compositions. However, knowledge on the effect of material and antagonist type on the wear characteristics of occlusal devices fabricated by using different methods is limited. PURPOSE: The purpose of this in vitro study was to evaluate the effect of material and antagonist type on the wear of occlusal devices fabricated by using conventional manufacturing, AM, and SM. MATERIAL AND METHODS: Two-hundred and forty Ø10×2-mm disk-shaped specimens were fabricated by using heat-polymerized polymethylmethacrylate (control, CM), AM clear device resin fabricated in 3 different orientations (horizontal [AMH], diagonal [AMD], and vertical [AMV]), SM polymethylmethacrylate (SMP), and SM ceramic-reinforced polyetheretherketone (SMB) (n=40). Specimens were then divided into 4 groups based on the antagonists: steatite ceramic (SC); multilayered zirconia (ZR); lithium disilicate (EX); and zirconia-reinforced lithium silicate (ZLS) used for thermomechanical aging (n=10). After aging, the volume loss (mm3) and maximum wear depth (µm) were digitally evaluated. Data were analyzed with 2-way analysis of variance and Tukey honestly significant difference tests (α=.05). RESULTS: The interaction between the device material and the antagonist affected volume loss and maximum depth of wear (P<.001). AMH had volume loss and depth of wear that was either similar to or higher than those of other materials (P≤.044). When SC was used, CM had higher volume loss and depth of wear than AMV, and, when EX was used, AMD had higher volume loss and depth of wear than SMP (P≤.013). SC and ZR led to higher volume loss of CM and AMH than EX and led to the highest depth of wear for these materials, while ZR also led to the highest volume loss and depth of wear of AMD and AMV (P≤.019). EX led to the lowest volume loss and depth of wear of AMV and SMP and to the lowest depth of wear of AMH (P≤.021). Regardless of the antagonist, SMB had the lowest volume loss and depth of wear (P≤.005). CONCLUSIONS: AMH mostly had higher volume loss and depth of wear, while SMB had the lowest volume loss, and its depth of wear was not affected by the tested antagonists. ZR mostly led to higher volume loss and maximum depth of wear, while EX mostly led to lower volume loss and maximum depth of wear of the tested occlusal device materials.

Fabrication trueness and internal fit of different lithium disilicate ceramics according to post-milling firing and material type.

OBJECTIVES: To evaluate whether post-milling firing and material type affect the fabrication trueness and internal fit of lithium disilicate crowns. METHODS: A prefabricated cobalt chromium abutment was digitized to design a mandibular right first molar crown. This design file was used to fabricate crowns from different lithium disilicate ceramics (nano-lithium disilicate (AM), fully crystallized lithium disilicate (IN), advanced lithium disilicate (TS), and lithium disilicate (EX)) (n = 10). Crowns, the abutment, and the crowns when seated on the abutment were digitized by using an intraoral scanner. Fabrication trueness was assessed by using the root mean square method, while the internal fit was evaluated according to the triple scan method. These processes were repeated after the post-milling firing of AM, TS, and EX. Paired samples t-tests were used to analyze the effect of post-milling firing within AM, TS, and EX, while all materials were compared with 1-way analysis of variance and Tukey HSD tests (α = 0.05). RESULTS: Post-milling firing reduced the surface deviations and internal gap of AM and EX (P ≤ 0.014). AM mostly had higher deviations and internal gaps than other materials (P ≤ 0.030). CONCLUSIONS: Post-milling firing increased the trueness and internal fit of tested nano-lithium disilicate and lithium disilicate ceramics. Nano-lithium disilicate mostly had lower trueness and higher internal gap; however, the maximum meaningful differences among tested materials were small. Therefore, the adjustment duration and clinical fit of tested crowns may be similar. CLINICAL SIGNIFICANCE: Tested lithium disilicate ceramics may be suitable alternatives to one another in terms of fabrication trueness and internal fit, considering the small differences in measured deviations and internal gaps.

Fabrication trueness and marginal quality of additively manufactured resin-based definitive laminate veneers with different restoration thicknesses.

OBJECTIVES: To evaluate how restoration thickness (0.5 mm and 0.7 mm) affects the fabrication trueness of additively manufactured definitive resin-based laminate veneers, and to analyze the effect of restoration thickness and margin location on margin quality. METHODS: Two maxillary central incisors were prepared either for a 0.5 mm- or 0.7 mm-thick laminate veneer. After acquiring the partial-arch scans of each preparation, laminate veneers were designed and stored as reference data. By using these reference data, a total of 30 resin-based laminate veneers were additively manufactured (n = 15 per thickness). All veneers were digitized and stored as test data. The reference and test data were superimposed to calculate the root mean square values at overall, external, intaglio, and marginal surfaces. The margin quality at labial, incisal, mesial, and distal surfaces was evaluated. Fabrication trueness at each surface was analyzed with independent t-tests, while 2-way analysis of variance was used to analyze the effect of thickness and margin location on margin quality (α = 0.05). RESULTS: Regardless of the evaluated surface, 0.7 mm-thick veneers had lower deviations (P < 0.001). Only the margin location (P < 0.001) affected the margin quality as labial margins had the lowest quality (P < 0.001). CONCLUSION: Restoration thickness affected the fabrication trueness of resin-based laminate veneers as 0.7 mm-thick veneers had significantly higher trueness. However, restoration thickness did not affect the margin quality and labial margins had the lowest quality. CLINICAL SIGNIFICANCE: Laminate veneers fabricated by using tested urethane-based acrylic resin may require less adjustment when fabricated in 0.7 mm thickness. However, marginal integrity issues may be encountered at the labial surface.

Dimensional Stability of Additively Manufactured Diagnostic Maxillary Casts Fabricated with Different Model Resins.

PURPOSE: To evaluate the effect of model resin type and time interval on the dimensional stability of additively manufactured diagnostic casts. MATERIALS AND METHODS: Ten irreversible hydrocolloid impressions and 10 impressions from an intraoral scanner were made from a reference maxillary stone cast, which was also digitized with a laboratory scanner. Conventional impressions were poured in type III stone (SC), while digital impressions were used to additively manufacture casts with a nanographene-reinforced model resin (GP) or a model resin (DM). All casts were digitized with the same laboratory scanner 1 day (T0), 1 week (T1), 2 weeks (T2), 3 weeks (T3), and 4 weeks (T4) after fabrication. Cast scans were superimposed over the reference cast scan to evaluate dimensional stability. Data were analyzed with Bonferroni-corrected repeated measures ANOVA (α = .05). RESULTS: The interaction between the main factors (material type and time interval) affected anterior teeth deviations, while the individual main factors affected anterior teeth and entire-cast deviations (P ≤ .008). Within anterior teeth, DM had the lowest deviations at T3, and GP mostly had lower values at T2 and lower deviations at T3 than at T0 (P ≤ .041). SC had the highest pooled anterior teeth deviations, and GP had the highest pooled entire cast deviations (P < .001). T3 had lower pooled anterior teeth deviations than at T0, T1, and T4, and higher pooled entire cast deviations than T1 were demonstrated (P ≤ .027). CONCLUSIONS: The trueness of nanographene-reinforced casts was either similar to or higher than that of other casts. Dimensional changes were acceptable during the course of 1 month.

Effect of Polymerization Unit, Polishing, and Coffee Thermocycling on the Color and Translucency of Additively Manufactured Resins Used for Definitive Prostheses.

PURPOSE: To evaluate the effect of polymerization unit, polishing, and coffee thermocycling on the color and translucency of additively manufactured polyurethane-based resins with different viscosities. In addition, their color behavior was compared with the color of the shade tab throughout the fabrication steps and aging. MATERIALS AND METHODS: Disk-shaped specimens (Ø10 × 2 mm) were fabricated from polyurethane-based resins with different viscosities (Tera Harz TC-80DP and C&B permanent; n = 30 per material). Baseline color coordinates were measured after cleaning. The specimens in each resin group were divided into three subgroups (n = 10 per subgroup) to be polymerized with different polymerization units (Otoflash G171 [FLN], Wash and Cure 2.0 [CLED1], and P Cure [CLED2]), polished, and subjected to coffee thermocycling. Color coordinates were remeasured after each process. Color differences (ΔE00) and relative translucency parameter (RTP) values were calculated. Data were statistically analyzed (α = .05). RESULTS: Time points and polymerization units affected the ΔE00 for each material (P ≤ .049). ΔE00 of each polymerization unit pair had significant differences within and among different time points within each material (P ≤ .024). ΔE00 (when compared with the shade tab) and RTP were mostly affected by polymerization units and time points within both materials (P ≤ .042). CONCLUSIONS: Tested polymerization units, polishing, and coffee thermocycling affected the color difference and translucency of tested resins. Color differences ranged from moderately unacceptable to extremely unacceptable, and the differences in translucency values mostly ranged from perceptible to unacceptable, according to previous thresholds. In addition, tested resin-polymerization unit pairs had unacceptable color differences when compared to the shade tab. CLED1 may enable higher color stability for tested resins.

Effect of coffee thermocycling on the surface roughness and stainability of denture base materials with different chemical compositions manufactured with additive and subtractive technologies.

OBJECTIVE: To evaluate the effect of coffee thermocycling (CTC) on the surface roughness (Ra ) and stainability of denture base materials with different chemical compositions fabricated by using additive and subtractive manufacturing. MATERIALS AND METHODS: Disk-shaped specimens were additively (FREEPRINT denture, AM) or subtractively (G-CAM, GSM and M-PM, SM) fabricated from three pink denture base materials in different chemical compositions (n = 10). Ra was measured before and after polishing, while color coordinates were measured after polishing. Specimens were subjected to CTC (5000 cycles) and measurements were repeated. Color differences (ΔE00 ) after CTC were calculated. Ra among different time intervals within materials was evaluated by using repeated measures analysis of variance (ANOVA), while 1-way ANOVA was used to evaluate the Ra of different materials within each time interval and the ΔE00 values. Color coordinates within each material were compared by using paired samples t-tests (α = 0.05). RESULTS: Ra before polishing was the highest for all materials (p < 0.001), while SM had its lowest Ra after CTC and AM had its lowest Ra after polishing (p ≤ 0.008). Before polishing, AM had the highest Ra among the materials (p < 0.001). After polishing, SM had higher Ra than AM (p < 0.001). After CTC, GSM had the lowest Ra (p ≤ 0.048). SM had the lowest (p ≤ 0.031) and AM had the highest (p < 0.001) ΔE00 . CTC decreased the a* and b* values of SM and AM (p ≤ 0.017), and increased the L* values of AM (p < 0.001). CONCLUSIONS: Polishing significantly reduced the surface roughness of all materials. CTC did not increase the surface roughness of materials above the clinically acceptable threshold. Only AM had perceptible color change when previously reported threshold values for denture base materials were considered. CLINICAL SIGNIFICANCE: Tested denture base materials may have similar surface stability after coffee thermocycling. However, subtractively manufactured denture base materials may have improved color stability when subjected to long-term coffee consumption.

Effect of Material Thickness and Coffee Thermocycling on the Color Stability and Translucency of Additively and Subtractively Manufactured Resin-Based Materials for Definitive Restorations.

PURPOSE: To evaluate the effect of material thickness and coffee thermocycling on the optical properties of definitive resin-based materials created via additive manufacturing (AM) and subtractive manufacturing (SM). MATERIALS AND METHODS: Specimens were prepared in three thicknesses (1, 1.5, and 2 mm) from three AM (3D-CB, 3D-TH, and 3D-CT) and two SM (G-CAM and VE) resin-based materials (n = 15 per material and thickness combination). Color coordinates of each specimen were measured after polishing and after 10,000 cycles of coffee thermocycling. Color differences (ΔE00s) and relative translucency parameter (RTP) values were calculated. After logarithmic transformation, ΔE00 values were analyzed with two-way ANOVA, while RTP values were analyzed with generalized linear model test (α = .05). RESULTS: 3D-TH had the highest pooled ΔE00 and G-CAM had the lowest (P ≤ .004). 3D-CB had higher pooled ΔE00 than VE and 3D-CT (P ≤ .002). For the SM group, the 1.5-mm and 2-mm 3DCT specimens and 1-mm 3D-TH specimens had lower ΔE00 than 1.5-mm and 2-mm 3D-TH specimens (P ≤ .036). Most of the AM specimens and 1-mm VE specimens had higher ΔE00 than 2-mm G-CAM specimens (P ≤ .029). Further, most AM specimens had higher ΔE00 than 1.5-mm G-CAM specimens (P ≤ .006). RTP values increased in order of 3D-CT, G-CAM, VE, 3D-CB, and 3D-TH specimens (P < .001). Increased thickness and coffee thermocycling mostly reduced RTP (P < .001). CONCLUSIONS: 3D-TH typically had higher color change values than SM specimens, while G-CAM typically had lower color change values than AM specimens. Only the 1.5-mm and 2-mm 3D-TH specimens had unacceptable color changes. Thickness and coffee thermocycling mostly reduced the translucency.

Influence of intraoral scanner and finish line location on the fabrication trueness and margin quality of additively manufactured laminate veneers fabricated with a completely digital workflow.

STATEMENT OF PROBLEM: Knowledge of the fabrication trueness and margin quality of additively manufactured (AM) laminate veneers (LVs) when different intraoral scanners (IOSs) and finish line locations are used is limited. PURPOSE: The purpose of this in vitro study was to evaluate the fabrication trueness and margin quality of AM LVs with different finish line locations digitized by using different IOSs. MATERIAL AND METHODS: An LV preparation with a subgingival (sub), equigingival (equi), or supragingival (supra) finish line was performed on 3 identical maxillary right central incisor typodont teeth. Each preparation was digitized by using 2 IOSs, (CEREC Primescan [PS] and TRIOS 3 [TS]), and a reference LV for each finish line-IOS pair (n=6) was designed. A total of 90 LVs were fabricated by using these files and urethane acrylate-based definitive resin (Tera Harz TC-80DP) (n=15). Each LV was then digitized by using PS to evaluate fabrication trueness (overall, external, intaglio, and marginal surfaces). Each LV was also qualitatively evaluated under a stereomicroscope (×60), and the cervical and incisal margin quality was graded. Fabrication trueness and cervical margin quality were evaluated by using 2-way analysis of variance, while Kruskal-Wallis and Mann Whitney-U tests were used to evaluate incisal margin quality (α=.05). RESULTS: The interaction between the IOS type and the finish line location affected measured deviations at each surface (P≤.020). PS-sub and TS-supra had higher overall trueness than their counterparts. and the subgingival finish line resulted in the lowest trueness (P≤.005). PS and the subgingival finish line led to the lowest trueness of the external surface (P≤.001). TS-sub had the lowest intaglio surface trueness among the TS subgroups, and PS-sub had higher trueness than TS-sub (P<.001). PS-sub and PS-supra had higher marginal surface trueness than their TS counterparts (P<.001). TS resulted in higher cervical margin quality (P=.001). CONCLUSIONS: Regardless of the IOS tested, subgingival finish lines resulted in the lowest trueness. The effect of IOS on the measured deviations varied according to the surface evaluated and finish line location. The cervical margin quality of AM LVs was higher when TS was used.

Stainability and translucency of potassium aluminum sulfate applied computer-aided design and computer-aided manufacturing materials after coffee thermocycling.

OBJECTIVE: The purpose of this in vitro study was to evaluate the effect of potassium aluminum sulfate (alum) application on the stainability and translucency of computer-aided design and computer-aided manufacturing (CAD-CAM) materials after coffee thermocycling (CTC). MATERIALS AND METHODS: Disk-shaped specimens (Ø10 × 1 mm; N = 200) were fabricated by using additively (Crowntec [CT] and Varseo Smile Crown Plus [VS]) and subtractively manufactured (Brilliant Crios [RCR], CEREC Block [FC], and Vita Enamic [VE]) CAD-CAM materials and polished. All specimens were randomly divided into two groups as alum applied and control (n = 10). All specimens were then subjected to CTC (10,000 cycles at 5-55°C) and color coordinates were measured at each time interval. Color differences (ΔE00 ) and relative translucency parameters (RTPs) were calculated and the data were statistically analyzed (a = 0.05). RESULTS: Among tested time intervals, alum applied specimens had their lowest ΔE00 after alum application (p ≤ 0.006), except for FC (p = 0.177). In addition, alum applied RCR had lower ΔE00 values than its control specimens (p = 0.029). Alum applied specimens had their lowest RTP after CTC (p < 0.001) and alum application decreased the RTP of CT (p = 0.010). CTC reduced the RTP of all materials in control groups (p < 0.001). Alum applied CT had higher RTP than its control specimens (p = 0.049). CONCLUSIONS: Alum application's effect on color change varied depending on the material and alum mostly resulted in clinically acceptable changes in translucency. CTC led to unacceptable color and translucency changes based on previously reported threshold values. CLINICAL SIGNIFICANCE: Optical properties of CAD-CAM materials and the sustainability of these properties over time is critical for longevity. Alum may improve the color stability of reinforced composite resin when subjected to long-term coffee consumption.

Effect of final temperature and heating rate on the mechanical and optical properties of a zirconia veneering ceramic.

PURPOSE: To evaluate the effect of firing temperature and heating rate on the volumetric shrinkage, translucency, flexural strength, hardness, and fracture toughness of a zirconia veneering ceramic. MATERIAL AND METHODS: Zirconia veneering ceramic specimens (N = 45) with varying final temperatures (730 °C, 750 °C, and 770 °C) and heating rates (70 °C/min, 55 °C/min, and 40 °C/min) were fabricated (n = 5). Each specimen's shrinkage, translucency, flexural strength, hardness, and fracture toughness were determined. Two-way analysis of variance, Scheffé test, and Pearson's correlation analysis were used to evaluate data (α = 0.05). RESULTS: The shrinkage (44.9 ± 3.1-47.5 ± 1.6 vol%) and flexural strength (74.1 ± 17.4-107.0 ± 27.1 MPa) were not affected by tested parameters (P ≥ 0.288). The interaction between the main factors affected the translucency, hardness, and fracture toughness of the specimens (P ≤ 0.007). Specimens with 770 °C final temperature and 70 °C/min heating rate had the lowest (21.8 ± 3.2 %) translucency (P ≤ 0.039). The hardness ranged between 4.98 ± 0.51 GPa (730 °C; 70 °C/min) and 5.60 ± 0.37 GPa (770 °C; 70 °C/min). Fracture toughness ranged between 0.54 ± 0.04 MPa√m and 0.67 ± 0.08 MPa√m with the highest values for specimens fired at 730 °C with 70 °C/min (P ≤ 0.001). There was a positive correlation between translucency and hardness (r = 0.335, P = 0.012), and a negative correlation between fracture toughness and all parameters other than shrinkage (translucency: r = -0.693/P < 0.001, flexural strength: r = -0.258/P = 0.046, hardness: r = -0.457/P < 0.001). CONCLUSIONS: Heating rate and final temperature should be considered while fabricating veneered zirconia restorations with tested ceramic as they affected the translucency, hardness, and fracture toughness.

Surface roughness, optical properties, and microhardness of additively and subtractively manufactured CAD-CAM materials after brushing and coffee thermal cycling.

PURPOSE: To evaluate the surface roughness, optical properties, and microhardness of additively or subtractively manufactured CAD-CAM materials after simulated brushing and coffee thermal cycling. MATERIAL AND METHODS: Two additively manufactured resins (Crowntec, CT and VarseoSmile Crown Plus, VS) and 3 subtractively manufactured materials (a reinforced composite (Brilliant Crios, BC), a polymer-infiltrated ceramic network (Enamic, VE), and a feldspathic ceramic (Mark II, VM)) were used to fabricate disk-shaped specimens (Ø10×1-mm) (n = 10). Surface roughness, Vickers microhardness, and color coordinates were measured after polishing, while surface roughness was also measured before polishing. Specimens were then subjected to 25000 cycles of brushing and 10000 cycles of coffee thermal cycling, and measurements were repeated after each time interval. Color difference (ΔE00 ) and relative translucency parameter (RTP) were calculated. Robust analysis of variance test was used to evaluate surface roughness, ΔE00 , and RTP data, while generalized linear model analysis was used for microhardness data (α = 0.05). RESULTS: Material type and time interval interaction affected tested parameters (p ≤ 0.002). In addition, material type affected all parameters (p < 0.001) other than surface roughness (p = 0.051), and time interval affected surface roughness and microhardness values (p < 0.001). Tested materials mostly had their highest surface roughness before polishing (p ≤ 0.026); however, there was no clear trend regarding the roughness of materials within different time intervals along with ΔE00 and RTP values within materials or time intervals. VS and CT had the lowest microhardness regardless of the time interval, while the remaining materials were listed as VM, VE, and BC in decreasing order (p < 0.001). Coffee thermal cycling only reduced the microhardness of VM (p < 0.001). CONCLUSIONS: Tested additively manufactured resins can be considered more susceptible to simulated brushing and coffee thermal cycling than the other materials, given the fact that their surface roughness and ΔE00 values were higher than previously reported acceptability thresholds and because they had the lowest microhardness after all procedures were complete.

Effect of coffee thermal cycling on the surface properties and stainability of additively manufactured denture base resins in different layer thicknesses.

PURPOSE: To compare the effect of coffee thermal cycling on surface roughness (Ra), Vickers microhardness (MH), and stainability of denture base resins additively manufactured in different layer thicknesses with those of subtractively manufactured denture base materials. MATERIALS AND METHODS: Eighty disk-shaped specimens (Ø10×2 mm) were fabricated from two subtractively (Merz M-PM [SM-M] and G-CAM [SM-G]) and three additively (NextDent 3D+ [50 µm, AM-N-50; 100 µm, AM-N-100], FREEPRINT Denture [50 µm, AM-F-50; 100 µm, AM-F-100], and Denturetec [50 µm, AM-S-50; 100 µm, AM-S-100]) manufactured denture base materials (n = 10). Ra measurements were performed before and after polishing by using a non-contact optical profilometer, while MH values and color coordinates were measured after polishing. Specimens were then subjected to 5000 cycles of coffee thermal cycling, all measurements were repeated, and color differences (ΔE00) were calculated. A linear mixed effect model was used to analyze Ra and MH data, while one-way analysis of variance was used to analyze ΔE00 data (α = 0.05). Ra values were further evaluated according to a clinically acceptable threshold of 0.2 µm, while ΔE00 values were evaluated according to perceptibility (1.72 units) and acceptability (4.08 units) thresholds. The interaction between the material type and the time interval affected both Ra and MH (p ≤ 0.001). Tested materials had their highest Ra before polishing (p ≤ 0.029). Before polishing, AM-F-100 had the highest, and SM-M and SM-G had the lowest Ra (p < 0.001). After polishing and after coffee thermal cycling, SM-G mostly had lower Ra than those of other materials (p ≤ 0.036). SM-G mostly had higher MH than that of other materials before and after coffee thermal cycling (p ≤ 0.025). Coffee thermal cycling reduced the MH of SM-M and increased that of AM-S-100 (p ≤ 0.024). AM-N-100 had higher ΔE00 than AM-F, AM-S-100, and SM-G (p ≤ 0.009), while AM-F and SM-G had lower ΔE00 than AM-S-50 and AM-N-50 (p ≤ 0.024). CONCLUSIONS: Polishing reduced the surface roughness of all materials, whereas the effect of coffee thermal cycling was nonsignificant. Most of the tested materials had acceptable surface roughness after polishing and after coffee thermal cycling according to the reported threshold. Layer thickness only affected the microhardness of tested additively manufactured resins, which was material-dependent. Subtractively manufactured specimens mostly had high microhardness and that of nonreinforced subtractively manufactured resin decreased after coffee thermal cycling. When reported color thresholds are considered, all materials had acceptable color stability.

Management of compromised spacing in the esthetic zone by combining an ultra-thin partial ceramic veneer and a ceramic implant crown: a case report of a multi-disciplinary approach and technique description.

Dental implants have been commonly used to replace missing single teeth. However, esthetic rehabilitation of an adjacent tooth may also be required due to diastemas, crowding, or existing large direct restorations to improve the final esthetic outcome. With the advancements in ceramics and bonding techniques, minimally invasive esthetic approaches have become viable for compromised spacing issues. This case report describes a dental technique for the esthetic rehabilitation of compromised anterior spacing with a customized zirconia implant abutment at maxillary central incisor site and a partial ceramic veneer bonded to adjacent central incisor.

Influence of age, training, intraoral scanner, and software version on the scan accuracy of inexperienced operators.

PURPOSE: To evaluate the effect of operator age on the scan accuracy (trueness and precision) of inexperienced operators when compared with experienced operators, and how training, intraoral scanner (IOS), and software version affect scan accuracy. MATERIAL AND METHODS: Thirty-four operators were sorted into groups: G1 (operators <25 years old, no experience), G2 (operators >40 years old, no experience), and G3 (experienced IOS operators). They conducted partial-arch scans before and after a 4-session training with two IOSs (Trios 3 and True Definition) and two software versions. These scans were compared with the reference scans obtained from conventional impressions and a laboratory scanner (IScan D103i) to evaluate trueness (mean root mean square values) and precision (standard deviation of root mean square values) with a software program (Geomagic Control X). Kruskal-Wallis and post-hoc Dunn's tests were used to evaluate the effect of age on the scan accuracy of inexperienced groups when compared with experienced operators, while the effect of training, IOS, and software version on scan accuracy was evaluated with Wilcoxon or Mann-Whitney U tests (α = 0.05). RESULTS: Before training, G1 and G2 scans had similar accuracy (p ≥ 0.065). After training, G1 scans had higher accuracy when IOS data was pooled and had higher precision with TD (p ≤ 0.004). Training increased the scan accuracy (p < 0.001), while newer software increased the trueness of inexperienced operator scans (p = 0.015). CONCLUSIONS: Age affected the scan accuracy of inexperienced operators after training, indicating that extended training may be required for older operators. Training increased the scan accuracy, and newer software increased the trueness of inexperienced operator scans.

Effect of polymerization unit, polishing, and coffee thermocycling on the color and translucency of additively manufactured resins used for definitive prostheses.

PURPOSE: To evaluate the effect of polymerization unit, polishing, and coffee thermocycling on the color and translucency of additively manufactured polyurethane-based resins with different viscosities. In addition, their color behavior was compared with the color of the shade tab throughout the fabrication steps and aging. MATERIALS AND METHODS: Disk-shaped specimens (Ø10x2 mm) were fabricated from polyurethane-based resins with different viscosities (Tera Harz TC-80DP and C&B permanent) (N=30). Baseline color coordinates were measured after cleaning. The specimens were divided into 3 to be polymerized with different polymerization units (Otoflash G171, FLN; Wash and Cure 2.0, CLED1; CARES P Cure, CLED2) (n=10), polished, and subjected to coffee thermocycling. Color coordinates were remeasured after each process. Color differences (ΔE00) and relative translucency parameter (RTP) values were calculated. Data were statistically analyzed (α=.05). RESULTS: Time points and polymerization units affected the ΔE00 for each material (P≤.049). ΔE00 of each polymerization unit pair had significant differences within and among different time points within each material (P≤.024). ΔE00, when compared with the shade tab, and RTP were mostly affected by polymerization units and time points within both materials (P≤.042). CONCLUSION: Tested polymerization units, polishing, and coffee thermocycling affected the color difference and translucency of tested resins. Color differences ranged from moderately unacceptable to extremely unacceptable and the differences in translucency values mostly ranged from perceptible to unacceptable according to previous thresholds. In addition, tested resin-polymerization unit pairs had unacceptable color differences when compared to the shade tab. CLED1 may enable higher color stability for tested resins.

Effect of scan powder and scanning technology on measured deviations of complete-arch implant supported frameworks digitized with industrial and intraoral scanners.

OBJECTIVES: To evaluate the suitability of intraoral scanners (IOSs) to analyze the fabrication trueness of titanium complete-arch implant-supported frameworks by comparing with an industrial-grade scanner and investigate how anti-reflective scan powder affects measured deviations. METHODS: Ten titanium complete-arch implant-supported frameworks were milled from a reference standard tessellation language (STL) file. An industrial-grade blue light scanner (ATOS Core 80 (AT)) and three IOSs (Primescan (PS), TRIOS T3 (T3), and TRIOS T4 (T4)) with (PS-P, T3-P, and T4-P) or without (PS, T3, and T4) anti-reflective scan powder application were used to generate test STL (TSTL) files of the frameworks. Reference STL and TSTLs were imported into a metrology-grade analysis software (Geomagic Control X) and whole surface root mean square (RMS) values were calculated. Another software (Medit Link v 2.4.4) was used to virtually isolate marginal surfaces of all STL files and marginal RMS values were calculated by using the same metrology-grade analysis software. A linear mixed effects model was used to compare the transformed deviations of the scans performed by using each IOS (with or without powder) with the deviations of those performed by using the reference AT scanner within each surface, where a Box-Cox type transformation was used for variance stability. Bonferroni corrected post-hoc tests were used to compare conditions within each IOS (α=0.05). RESULTS: All IOSs had significantly higher whole surface and marginal RMS values than AT, regardless of the condition (P≤.002). However, scan powder application did not affect the whole surface and marginal RMS values in scans of tested IOSs (P≥.054). CONCLUSION: Measured whole surface and marginal deviations in all IOS scans performed with or without the use of scan powder were higher than those in AT scans. The application of anti-reflective scan powder did not affect the deviations in scans of tested IOSs. CLINICAL SIGNIFICANCE: Even though deviations measured in the scans of tested scanners were significantly different than those in the reference scanner, the maximum raw mean difference was 37.33 µm and the maximum raw confidence interval value of estimated differences was 47.88 µm, which can be considered clinically small taking into account the size of the frameworks tested. Therefore, tested intraoral scanners may be feasible to scan prostheses similar to or smaller than tested frameworks for fabrication trueness analysis, which may facilitate potential clinical adjustments.