Accuracy of digital complete-arch, multi-implant scans made in the edentulous jaw with gingival movement simulation: An in vitro study.

STATEMENT OF PROBLEM: The use of computer-aided design and computer-aided manufacturing (CAD-CAM) technologies is widely established, with single restorations or short fixed partial dentures having similar accuracy when generated from digital scans or conventional impressions. However, research on complete-arch scanning of edentulous jaws is sparse. PURPOSE: The purpose of this pilot in vitro study was to compare the accuracy of a digital scan with the conventional method in a workflow generating implant-supported complete-arch prostheses and to establish whether interference from flexible soft tissue segments affects accuracy. MATERIAL AND METHODS: An edentulous maxillary master cast containing 6 angled implant analogs was used and digitized with mounted scan bodies by using a high-precision laboratory scanner. The master cast was then scanned 10 times with 4 different intraoral scanners: TRIOS 3 with a complete-arch scanning strategy (TRI1) or implant-scanning strategy (TRI2), TRIOS Color (TRC), CEREC Omnicam (CER), and CEREC Primescan (PS). The same procedure was repeated with 4 different levels of free gingiva (G0-G3). Ten conventional impressions were obtained. Differences in implant position and direction were evaluated at the implant shoulder as mean values for trueness and interquartile range (IQR) for precision. Statistical analysis was performed by using the Kruskal-Wallis and post hoc Conover tests (α=.05). RESULTS: At G0, position deviations ranged from 34.8 µm (IQR 23.0 µm) (TRC) to 68.3 µm (12.2 µm) (CER). Direction deviations ranged from 0.34 degrees (IQR 0.18 degrees) (conventional) to 0.57 degrees (IQR 0.37 degrees) (TRI2). For digital systems, the position deviation ranged from 48.4 µm (IQR 5.9 µm) (PS) to 76.6 µm (IQR 8.1 µm) (TRC) at G1, from 36.3 µm (IQR 9.3 µm) (PS) to 79.9 µm (IQR 36.1 µm) (TRI1) at G2, and from 51.8 µm (IQR 14.3 µm) (PS) to 257.5 µm (IQR 106.3 µm) (TRC) at G3. The direction deviation ranged from 0.45 degrees (IQR 0.15 degrees) (CER) to 0.64 degrees (IQR 0.20 degrees) (TRC) at G1, from 0.38 degrees (IQR 0.05 degrees) (PS) to 0.925 degrees (IQR 0.09 degrees) (TRI) at G2, and from 0.44 degrees (IQR 0.07 degrees) (PS) to 1.634 degrees (IQR 1.08 degrees) (TRI) at G3. Statistical analysis revealed significant differences among the test groups for position (G0: P<.001; G1: P<.05; G2: P<.001; G3: P<.001) and direction (G0: P<.005; G1: P<.001; G2: P<.001; G3: P<.001). CONCLUSIONS: Without soft tissue interference, the accuracy of certain digital scanning systems was comparable with that of the conventional impression technique. The amount of flexible soft tissue interference affected the accuracy of the digital scans.

Fracture load of three-unit full-contour fixed dental prostheses fabricated with subtractive and additive CAD/CAM technology.

OBJECTIVES: The aim of this study was to test the fracture load of ceramic and composite three-unit full-contour fixed dental prostheses (FDPs) fabricated with additive and subtractive computer-aided design (CAD)/computer-aided manufacturing (CAM) technology. MATERIALS AND METHODS: A newly developed alveolar socket replica model for a three-unit FDP replacing one molar was used in this study. Five CAD/CAM materials were used for fabrication of three-unit FDPs (each n = 12). The subtractive CAD/CAM fabrication method was used for groups BC (BRILLIANT Crios), TC (Telio CAD), EX (e.max CAD), and TZ (inCoris TZI C), and the additive method was used for group 3D (els 3D resin even stronger). FDPs were adhesively seated to the abutment dies (PANAVIA V5 system). Thermomechanical loading was performed prior to fracture testing with a universal testing machine. The data for maximum fracture load values was analyzed with one-way ANOVA and post hoc Scheffé test (α = 0.05). RESULTS: All FDPs survived the thermomechanical loading test. Statistically significant differences were found for the fracture load of three-unit FDPs fabricated from different CAD/CAM materials (p < 0.05). The highest mean fracture load was found for group TZ (2099.5 ± 382.1 N). Group 3D showed the lowest mean fracture load (928.9 ± 193.8 N). Group BC performed statistically significantly differently from group 3D with a mean fracture load of 1494.8 ± 214.5 N (p < 0.05). CONCLUSIONS: Particle-filled composite resin CAD/CAM materials showed fracture load values within the range of ceramic materials with a specific indication of use for three-unit FDPs. CLINICAL RELEVANCE: Particle filled composite CAD/CAM materials may offer new treatment possibilities for the CAD/CAM workflow.

A volumetric assessment and follow-up of a granuloma gravidarum in the anterior maxilla.

AIM: Granuloma gravidarum (GG) is a benign lesion of the soft tissue. The aim of this technical note is the volumetric assessment and follow-up 3D measurement of a GG in the anterior maxilla. MATERIALS AND METHODS: A 35-year-old female patient who was 7 months pregnant was referred due to a soft tissue tumor in the papilla of tooth 21. A biopsy verified a pyogenic granuloma gravidarum. Initial and consecutive volumeatric measurements were made with an intraoral scanner during the patient's pregnancy and until 16 months postpartum. RESULTS: The volumetric assessment showed a continuous growth of the tumor and a consecutive volume reduction 16 months postpartum. In comparison with the level of the papilla of the contralateral incisor, there was an almost complete remission at the last follow-up. CONCLUSION: Intraoral scans can serve for the volumetric assessment of soft tissue tumors of the alveolar crest. Image superimposition enables the quantification of changes in morphology. This supports clinical follow-ups and enables the quantification of clinical observations.

Fracture load of CAD/CAM-fabricated and 3D-printed composite crowns as a function of material thickness.

OBJECTIVES: Indirect CAD/CAM restorations can be fabricated using both subtractive and additive CAD/CAM technology. This study investigated the fracture load of crowns fabricated from three particle-filled composite CAD/CAM materials and one 3D-printed composite material. MATERIALS AND METHODS: Lava Ultimate, Cerasmart and Brilliant Crios were used as particle-filled composite CAD/CAM material and els-3D Harz as 3D-printed composite material. For each group, crowns with three different material thicknesses (0.5/1.0/1.5 mm) were fabricated. Control group was composed of ceramic-based CAD/CAM materials e.max CAD and Enamic. Totally, n = 180 crowns were fabricated and adhesively seated on SLA fabricated dies. Thermomechanical loading and fracture testing were performed. The data for fracture loading force were statistically analyzed by two-way ANOVA followed with multiple comparisons by post hoc Tukey's test (α = 0.05). RESULTS: In contrast to ceramics, all particle-filled composite crowns with 0.5-mm thickness survived fatigue testing. Forces varied statistically significantly. Brilliant Crios showed highest maximum loading force with 1580.4 ± 521.0 N (1.5 mm). Two-way ANOVA indicated that both the material and the thickness affected the fracture load (p < 0.05). CONCLUSIONS: Particle-filled composite resin CAD/CAM materials may have advantageous material characteristics compared to ceramic CAD/CAM materials for minimal restoration thicknesses. CLINICAL RELEVANCE: Composite-based CAD/CAM materials may offer new possibilities in minimally invasive restorative treatment concepts.

Accuracy of complete- and partial-arch impressions of actual intraoral scanning systems in vitro.

OBJECTIVE: Intraoral scanners (IOSs) are widely used for obtaining digital dental models directly from the patient. Additionally, improvements in IOSs are made from generation to generation. The aim of this study was to evaluate the accuracy of new and actual IOS devices for complete- and partial-arch dental impressions in an in vitro setup. MATERIALS AND METHODS: A custom maxillary complete-arch cast with teeth made from feldspar ceramic material was used as the reference cast and digitized with a reference scanner (ATOS III Triple Scan MV60). One conventional impression technique using polyvinylsiloxane (PVS) material (President) served as the control (CO), and eight different IOS devices comprising different hardware and software configurations (TRn: Trios 3; TRi: Trios 3 insane; CS: Carestream Dental CS 3600; MD: Medit i500; iT: iTero Element 2; OC4: Cerec Omnicam 4.6.1; OC5: Cerec Omnicam 5.0.0; PS: Primescan) were used to take complete-arch impressions from the reference cast. The impressions were repeated 10 times (n = 10) for each group. Conventional impressions were poured with type IV gypsum and digitized with a laboratory scanner (inEos X5). All datasets were obtained in standard tessellation language (STL) file format and cut to either complete-arch, anterior segment, or posterior segment areas for respective analysis. Values for trueness and precision for the respective areas were evaluated using a three-dimensional (3D) superimposition method with special 3D difference analysis software (GOM Inspect) using (90-10)/2 percentile values. Statistical analysis was performed using either one-way analysis of variance (ANOVA) or Kruskal-Wallis test (α = 0.05). Results are given as median and interquartile range [IQR] values in µm. RESULTS: Statistically significant differences were found between test groups for complete- and partial-arch impression methods in vitro (p < 0.05). Values ranged from 16.3 [2.8] µm (CO) up to 89.8 [26.1] µm (OC4) for in vitro trueness, and from 10.6 [3.8] µm (CO) up to 58.6 [38.4] µm (iT) for in vitro precision for the complete-arch methods. The best values for trueness of partial-arch impressions were found for the posterior segment, with 9.7 [1.2] µm for the conventional impression method (CO), and 21.9 [1.5] µm (PS) for the digital impression method. CONCLUSION: Within the limitations of this study, digital impressions obtained from specific IOSs are a valid alternative to conventional impressions for partial-arch segments. Complete-arch impressions are still challenging for IOS devices; however, certain devices were shown to be well within the required range for clinical quality. Further in vivo studies are needed to support these results.

Trueness of four different milling procedures used in dental CAD/CAM systems.

OBJECTIVES: Milling is a crucial step in producing restorations using computer-aided design and computer-aided manufacturing (CAD/CAM) systems. In this study the trueness of currently available milling devices was evaluated. MATERIALS AND METHODS: Thirty clinical cases (ten inlays, ten crowns, ten onlays) were milled from ceramic blocks using four different milling approaches: five axis with IMES CORiTEC 450i, four axis with CEREC MCXL, four axis with CEREC MCXL-EF and five axis with inLab MCX5. The milled restorations were scanned and the occlusal and inner surfaces compared to the originally calculated 3D surface using difference analysis software. The (90-10 %) / 2 percentile of the distances were calculated and analysed using one-way ANOVA with the post hoc Scheffé test (α = 0.05). Chipping of marginal areas were visually examined and analysed using one-way ANOVA with a post hoc Tamhane test (α = 0.05). RESULTS: At inner surfaces, the milling trueness of IMES (33.9 ± 16.3 µm), X5 (32.3 ± 9.7 µm) and MCXL-EF (34.4 ± 7.5 µm) was significantly better (p < 0.001) than that of MCXL (62.1 ± 17.1 µm). At occlusal surfaces, MCXL-EF (25.7 ± 9.3 µm) showed significant higher accuracy (p < 0.001) than MCXL (48.7 ± 23.3 µm) and X5 (40.9 ± 20.4 µm). IMES produced the most chipping (p < 0.001). CONCLUSIONS: Five-axis milling devices yield high trueness. MCXL-EF is competitive and may allow chairside fabrication with good milling results. CLINICAL RELEVANCE: Accurate milling is required for well-fitting restorations and thereby requires fewer manual finishing steps, yields smaller marginal gaps, resistance to secondary caries and longevity of restorations.

In vivo tooth-color measurement with a new 3D intraoral scanning system in comparison to conventional digital and visual color determination methods.

STATEMENT OF PROBLEM: Three-dimensional (3D) intraoral scanning systems allow for the simultaneous acquisition of 3D information about tooth surfaces and a photorealistic view of the patient's tooth colors. AIM: The goal of this study was the in vivo comparison of a new 3D scanner with a color acquisition mode and conventional visual and digital color measurements. MATERIALS AND METHODS: The colors of 40 teeth of 20 patients were evaluated in seven ways: 1) By dentists using the Vita 3D-Master; 2) By dental technicians using the Vita 3D-Master; 3) With the 3Shape Trios device; 4) With the Vita Easyshade device; 5) With the Vita Easyshade Advance device; 6) With the SpectroShade device; and 7) With the SpectroShade Micro device. Digital measurements of Groups 3 to 7 were repeated three times for each tooth. For all groups, both the CIE Lab values and the Vita 3D-Master values were recorded. The repeatability and relative accuracy of the Vita 3D-Master values were analyzed statistically using Pearson's chi-squared test (α < 0.05). ΔE values were calculated from the CIE Lab values, which served as a basis for performing multidimensional scaling (MDS) and evaluating differences between the groups using the one-way ANOVA with post hoc Tamhane's test (α < 0.05). RESULTS: The results of the ΔE values showed that clinically relevant differences between the evaluation by dentists, dental technicians, and the intraoral scanning device (3Shape) are negligible. The intraoral 3D scanning device (Group 3) and the digital systems (Groups 4 to 7) did not differ significantly in the repeatability of color shade management. The SpectroShade Micro (Group 7) had significantly better relative accuracy than the other devices. CONCLUSIONS: The results demonstrate that intraoral scanning systems can be used to measure both tooth color and tooth surface in 3D. CLINICAL IMPLICATIONS: Intraoral optical scanning devices allow for the acquisition of accurate 3D surface data. Tooth color can be evaluated simultaneously and can be used to determine the color of restorations without requiring additional conventional color-measurement methods.

In vivo precision of conventional and digital methods for obtaining quadrant dental impressions.

OBJECTIVES: Quadrant impressions are commonly used as alternative to full-arch impressions. Digital impression systems provide the ability to take these impressions very quickly; however, few studies have investigated the accuracy of the technique in vivo. The aim of this study is to assess the precision of digital quadrant impressions in vivo in comparison to conventional impression techniques. MATERIALS AND METHODS: Impressions were obtained via two conventional (metal full-arch tray, CI, and triple tray, T-Tray) and seven digital impression systems (Lava True Definition Scanner, T-Def; Lava Chairside Oral Scanner, COS; Cadent iTero, ITE; 3Shape Trios, TRI; 3Shape Trios Color, TRC; CEREC Bluecam, Software 4.0, BC4.0; CEREC Bluecam, Software 4.2, BC4.2; and CEREC Omnicam, OC). Impressions were taken three times for each of five subjects (n = 15). The impressions were then superimposed within the test groups. Differences from model surfaces were measured using a normal surface distance method. Precision was calculated using the Perc90_10 value. The values for all test groups were statistically compared. RESULTS: The precision ranged from 18.8 (CI) to 58.5 µm (T-Tray), with the highest precision in the CI, T-Def, BC4.0, TRC, and TRI groups. The deviation pattern varied distinctly depending on the impression method. Impression systems with single-shot capture exhibited greater deviations at the tooth surface whereas high-frame rate impression systems differed more in gingival areas. Triple tray impressions displayed higher local deviation at the occlusal contact areas of upper and lower jaw. CONCLUSIONS: Digital quadrant impression methods achieve a level of precision, comparable to conventional impression techniques. However, there are significant differences in terms of absolute values and deviation pattern. CLINICAL RELEVANCE: With all tested digital impression systems, time efficient capturing of quadrant impressions is possible. The clinical precision of digital quadrant impression models is sufficient to cover a broad variety of restorative indications. Yet the precision differs significantly between the digital impression systems.

In vivo precision of conventional and digital methods of obtaining complete-arch dental impressions.

STATEMENT OF PROBLEM: Digital impression systems have undergone significant development in recent years, but few studies have investigated the accuracy of the technique in vivo, particularly compared with conventional impression techniques. PURPOSE: The purpose of this in vivo study was to investigate the precision of conventional and digital methods for complete-arch impressions. MATERIAL AND METHODS: Complete-arch impressions were obtained using 5 conventional (polyether, POE; vinylsiloxanether, VSE; direct scannable vinylsiloxanether, VSES; digitized scannable vinylsiloxanether, VSES-D; and irreversible hydrocolloid, ALG) and 7 digital (CEREC Bluecam, CER; CEREC Omnicam, OC; Cadent iTero, ITE; Lava COS, LAV; Lava True Definition Scanner, T-Def; 3Shape Trios, TRI; and 3Shape Trios Color, TRC) techniques. Impressions were made 3 times each in 5 participants (N=15). The impressions were then compared within and between the test groups. The cast surfaces were measured point-to-point using the signed nearest neighbor method. Precision was calculated from the (90%-10%)/2 percentile value. RESULTS: The precision ranged from 12.3 µm (VSE) to 167.2 µm (ALG), with the highest precision in the VSE and VSES groups. The deviation pattern varied distinctly according to the impression method. Conventional impressions showed the highest accuracy across the complete dental arch in all groups, except for the ALG group. CONCLUSIONS: Conventional and digital impression methods differ significantly in the complete-arch accuracy. Digital impression systems had higher local deviations within the complete arch cast; however, they achieve equal and higher precision than some conventional impression materials.

Non- and minimally invasive full-mouth rehabilitation of patients with loss of vertical dimension of occlusion using CAD/CAM: an innovative concept demonstrated with a case report.

Abrasion and erosion are two increasingly common indications for dental treatment. Thanks to modern digital technologies and new restorative materials, there are novel therapeutic approaches to restoring such losses of tooth structure in a virtually non-invasive manner. The case study in this article demonstrates one such innovative approach. The patient's severely abraded natural dentition was restored in a defect-driven, minimally invasive manner using high-performance composite materials in the posterior region, and the "sandwich technique" in the anterior region. The restorations were milled on an optimized milling machine with milling cycles adapted for the fabrication of precision-fit restorations with thin edges.

A 3-dimensional accuracy analysis of chairside CAD/CAM milling processes.

STATEMENT OF PROBLEM: Milling is a central and important aspect of computer-aided design and computer-aided manufacturing (CAD/CAM) technology. High milling accuracy reduces the time needed to adapt the workpiece and provides restorations with better longevity and esthetic appeal. The influence of different milling processes on the accuracy of milled restorations has not yet been reviewed. PURPOSE: The purpose of this study was to investigate the influence of different milling processes on the accuracy of ceramic restorations. MATERIAL AND METHODS: Four groups of partial crowns were milled (each n = 17): Three groups in a 4-axial milling unit: (1) 1-step mode and Step Bur 12S (12S), (2) 1-step mode and Step Bur 12 (1Step), (3) 2-step mode and Step Bur 12 (2Step), and (4) one group in a 5-axial milling unit (5axis). The milled occlusal and inner surfaces were scanned and superimposed over the digital data sets of calculated restorations with specialized difference analysis software. The trueness of each restoration and each group was measured. One-way ANOVA with a post hoc Tukey test was used to compare the data (α = .05). RESULTS: The highest trueness for the inner surface was achieved in group 5axis (trueness, 41 ± 15 µm, P<.05). The 4-axial milling unit exhibited trueness at settings ranging from 61 µm (2Step) to 96 µm (12S). For the occlusal surface, the highest trueness was achieved with group 5axis (trueness, 42 ± 10 µm). The 4-axial milling unit exhibited trueness at settings ranging from 55 µm (1Step) to 76 µm (12S). CONCLUSIONS: Restorations milled with a 5-axial milling unit have a higher trueness than those milled with a 4-axial milling unit. A rotary cutting instrument with a smaller diameter results in a more accurate milling process. The 2-step mode is not significantly better than the 1-step mode.

Impact of the sintering parameters on the grain size, crystal phases, translucency, biaxial flexural strength, and fracture load of zirconia materials.

OBJECTIVES: To investigate the influence of the zirconia and sintering parameters on the optical and mechanical properties. METHODS: Three zirconia materials (3/4Y-TZP, 4Y-TZP, 3Y-TZP) were high-speed (HSS), speed (SS) or conventionally (CS) sintered. Disc-shaped specimens nested in 4 vertical layers of the blank were examined for grain size (GS), crystal phases (c/t'/t/m-phase), translucency (T), and biaxial flexural strength. Fracture load (FL) of three-unit fixed dental prostheses was determined initially and after thermomechanical aging. Fracture types were classified, and data statistically analyzed. RESULTS: 4Y-TZP showed a higher amount of c + t'-phase and lower amount of t-phase, and higher optical and lower mechanical properties than 3Y-TZP. In all materials, T declined from Layer 1 to 4. 3/4Y-TZP showed the highest FL, followed by 3Y-TZP, while 4Y-TZP showed the lowest. In 4Y-TZP, the sintering parameters exercised a direct impact on GS and T, while mechanical properties were largely unaffected. The sintering parameters showed a varying influence on 3Y-TZP. Thermomechanical aging resulted in comparable or higher FL. CONCLUSION: 3/4Y-TZP presenting the highest FL underscores the principle of using strength-gradient multi-layer blanks to profit from high optical properties in the incisal area, while ensuring high mechanical properties in the lower areas subject to tensile forces. With all groups exceeding maximum bite forces, the examined three-unit FDPs showed promising long-term mechanical properties.

The effect of zirconia sintering temperature on flexural strength, grain size, and contrast ratio.

OBJECTIVE: This study investigated the effect of sintering temperatures on flexural strength, contrast ratio, and grain size of zirconia. MATERIALS AND METHODS: Zirconia specimens (Ceramill ZI, Amann Girrbach) were prepared in partially sintered state. Subsequently, the specimens were randomly divided into nine groups and sintered with different final sintering temperatures: 1,300°C, 1,350°C, 1,400°C, 1,450°C, 1,500°C, 1,550°C, 1,600°C, 1,650°C, or 1,700°C with 120 min holding time. Three-point flexural strength (N = 198; n = 22 per group) was measured according to ISO 6872: 2008. The contrast ratio (N = 90; n = 10 per group) was measured according to ISO 2471: 2008. Grain sizes and microstructure of different groups were investigated (N = 9, n = 1 per group) with scanning electron microscope. Data were analyzed using one-way ANOVA with Scheffé test and Weibull statistics (p < 0.05). Pearson correlation coefficient was calculated between either flexural strength or contrast ratio and sintering temperatures. RESULTS: The highest flexural strength was observed in groups sintered between 1,400°C and 1,550°C. The highest Weibull moduli were obtained for zirconia sintered at 1,400°C and the lowest at 1,700°C. The contrast ratio and the grain size were higher with the higher sintering temperature. The microstructure of the specimens sintered above 1,650°C exhibited defects. Sintering temperatures showed a significant negative correlation with both the flexural strength (r = -0.313, p < 0.001) and the contrast ratio values (r = -0.96, p < 0.001). CONCLUSIONS: The results of this study showed that the increase in sintering temperature increased the contrast ratio, but led to a negative impact on the flexural strength. CLINICAL RELEVANCE: Considering the flexural strength values and Weibull moduli, the sintering temperature for the zirconia tested in this study should not exceed 1,550°C.

Accuracy of complete-arch dental impressions: a new method of measuring trueness and precision.

STATEMENT OF PROBLEM: A new approach to both 3-dimensional (3D) trueness and precision is necessary to assess the accuracy of intraoral digital impressions and compare them to conventionally acquired impressions. PURPOSE: The purpose of this in vitro study was to evaluate whether a new reference scanner is capable of measuring conventional and digital intraoral complete-arch impressions for 3D accuracy. MATERIAL AND METHODS: A steel reference dentate model was fabricated and measured with a reference scanner (digital reference model). Conventional impressions were made from the reference model, poured with Type IV dental stone, scanned with the reference scanner, and exported as digital models. Additionally, digital impressions of the reference model were made and the digital models were exported. Precision was measured by superimposing the digital models within each group. Superimposing the digital models on the digital reference model assessed the trueness of each impression method. Statistical significance was assessed with an independent sample t test (α=.05). RESULTS: The reference scanner delivered high accuracy over the entire dental arch with a precision of 1.6 ±0.6 µm and a trueness of 5.3 ±1.1 µm. Conventional impressions showed significantly higher precision (12.5 ±2.5 µm) and trueness values (20.4 ±2.2 µm) with small deviations in the second molar region (P<.001). Digital impressions were significantly less accurate with a precision of 32.4 ±9.6 µm and a trueness of 58.6 ±15.8µm (P<.001). More systematic deviations of the digital models were visible across the entire dental arch. CONCLUSIONS: The new reference scanner is capable of measuring the precision and trueness of both digital and conventional complete-arch impressions. The digital impression is less accurate and shows a different pattern of deviation than the conventional impression.

Fracture load of milled polymeric fixed dental prostheses as a function of connector cross-sectional areas.

STATEMENT OF PROBLEM: Polymeric computer-aided design/computer-aided manufacturing (CAD/CAM) blocks exhibit various advantages in contrast to conventionally processed resin restorations. However, the influence of connector dimensions on resin fixed dental prostheses (FDPs) has not yet been investigated. PURPOSE: This study evaluated the impact of connector cross-sectional area (CSA) on the fracture load of 3-unit CAD/CAM FDPs and compared this with conventionally fabricated ones. MATERIAL AND METHODS: Anatomically shaped 3-unit FDPs with the CSAs of 6, 9, 12, and 16 mm(2) (N=240, n=15 per material and per CSA) were fabricated from the following CAD/CAM materials: artBloc Temp (AT), TelioCAD (TC), CAD-Temp (CT), and one conventional resin material, CronMix K (CMK) as the control group. The fracture load was tested and the data were analyzed with 2-way ANOVA, 1-way ANOVA, the Scheffé post hoc test, and Weibull statistics (α=05). RESULTS: CMK showed the significant lowest values for all CSAs followed by CT, except for the 12 mm(2) connector (P<.001). The CAD/CAM FDPs exhibited a significant increase in fracture load with the increase of CSA (P<.001). Conventionally fabricated FDPs presented an increase of values up to the CSA of 12 mm(2). For TC, the shape increased with a larger CSA. The other materials exhibited no tendencies in this regard. Among the 12 mm(2) groups, AT exhibited the highest shape value (19.1), and among the 16 mm(2) groups, TC showed the highest shape value (17.0). The CMK FDPs with a CSA of 16 mm(2) showed almost half as high a shape parameter (6.4) than the other three CSAs. CONCLUSIONS: CAD/CAM resin FDPs revealed significantly higher fracture load values than conventionally fabricated FDPs and showed a significant increase in fracture load with the increase of the CSA.

Load-bearing capacity of CAD/CAM milled polymeric three-unit fixed dental prostheses: effect of aging regimens.

OBJECTIVE: This study tested the fracture load of milled and conventionally fabricated polymeric and glass-ceramic three-unit fixed dental prostheses (FDPs) after aging. MATERIALS AND METHODS: FDPs were fabricated (N = 1,050) from four computer-aided design and computer-aided manufacturing (CAD/CAM) resins: (1) AT (artBlock Temp); (2) TC (Telio CAD); (3) ZP (ZENO PMMA); (4) CT (CAD-Temp); two conventionally fabricated resins, (5) IES (integral esthetic press), (6) CMK (CronMix K), and a glass-ceramic (control) (7) PG (IMAGINE PressX). Specimens of each group were tested immediately after fabrication (n = 15 per material). Seventy-five FDPs per material type were stored in artificial saliva (37°C) and 15 of them were randomly selected after aging (1, 7, 28, 90, and 180 days) for fracture load measurement. The remaining specimens (n = 60 per material) were subjected to chewing simulation (×120.000-1.200.000, 49 N, 5°C/50°C). The data were analyzed using two-way and one-way ANOVA followed by Scheffé test. RESULTS: The interactions between FDP materials and aging time in both storage media showed a significant impact on the results (p < 0.001). Among saliva storage groups, TC and ZP showed the highest, and PG the lowest fracture load (p < 0.05). AT and CT were not affected from chewing simulation. TC, ZP, and AT presented the highest in ascending order (p < 0.05), PG and CMK showed the lowest fracture load after chewing simulation (p < 0.001). CONCLUSIONS: Aging did not influence the fracture load of FDPs made of CAD/CAM resins. FDPs made of glass-ceramic showed significantly lower fracture load than those of all resin FDPs. CLINICAL RELEVANCE: Considering fracture load measurements, CAD/CAM resins tested could be alternative materials to glass-ceramic for FDP construction.

Impact of Gluma Desensitizer on the tensile strength of zirconia crowns bonded to dentin: an in vitro study.

This study tested the impact of Gluma Desensitizer on the tensile strength of zirconia crowns bonded to dentin. Human teeth were prepared and randomly divided into six groups (N = 144, n = 24 per group). For each tooth, a zirconia crown was manufactured. The zirconia crowns were cemented with: (1) Panavia21 (PAN), (2) Panavia21 combined with Gluma Desensitizer (PAN-G), (3) RelyX Unicem (RXU), (4) RelyX Unicem combined with Gluma Desensitizer (RXU-G), (5) G-Cem (GCM) and (6) G-Cem combined with Gluma Desensitizer (GCM-G). The initial tensile strength was measured in half (n = 12) of each group and the other half (n = 12) subjected to a chewing machine (1.2 Mio, 49 N, 5°C/50°C). The cemented crowns were pulled in a Universal Testing Machine (1 mm/min, Zwick Z010) until failure occurred and tensile strength was calculated. Data were analyzed with one-way and two-way ANOVA followed by a post hoc Scheffé test, t test and Kaplan-Meier analysis with a Breslow-Gehan analysis test (α = 0.05). After the chewing simulation, the self-adhesive resin cements combined with Gluma Desensitizer showed significantly higher tensile strength (RXU-G, 12.8 ± 4.3 MPa; GCM-G, 13.4 ± 6.2 MPa) than PAN (7.3 ± 1.7 MPa) and PAN-G (0.9 ± 0.6). Within the groups, PAN, PAN-G and RXU resulted in significantly lower values when compared to the initial tensile strength; the values of all other test groups were stable. In this study, self-adhesive resin cements combined with Gluma Desensitizer reached better long-term stability compared to PAN and PAN-G after chewing simulation.

Effect of surface conditioning with airborne-particle abrasion on the tensile strength of polymeric CAD/CAM crowns luted with self-adhesive and conventional resin cements.

STATEMENT OF PROBLEM: Adhesively bonded, industrially polymerized resins have been suggested as definitive restorative materials. It is claimed that such resins present similar mechanical properties to glass ceramic. PURPOSE: The purpose of this study was to assess the tensile strength of polymeric crowns after conditioning with 2 different protocols: luted with self-adhesive or with conventional resin cements to dental abutments. MATERIAL AND METHODS: Human teeth were prepared for crowns and divided into 13 groups (N=312, n=24 per group). Polymeric crowns were CAD/CAM fabricated and divided into 3 groups depending on different surface conditioning methods: A) No treatment, B) airborne-particle abrasion with 50 µm alumina, and C) airborne-particle abrasion with 110 µm alumina. Thereafter, the crowns were luted on dentin abutments with the following cements: 1) RXU (RelyX Unicem, self-adhesive), 2) GCM (G-Cem, self-adhesive), 3) ACG (artCem GI, conventional), and 4) VAR (Variolink II, conventional). Glass ceramic crowns milled and cemented with dual-polymerized resin cement (Variolink II) served as the control group. The tensile strength was measured initially (n=12) and after aging by mechanical thermocycling loading (1 200 000 cycles, 49 N, 5°C to 50°C) (n=12). The tensile strength (MPa) of all crowns was determined by the pull-off test (Zwick/Roell Z010; Ulm, Germany, 1mm/min). Subsequently, the failure types were classified. Data were analyzed with 2-way and 1-way ANOVA followed by a post hoc Scheffé test and t test (α=.05). RESULTS: No adhesion of the tested cements was observed on unconditioned polymeric CAD/CAM crowns and those luted with VAR. Among the tested cements, GCM showed significantly higher values after airborne-particle abrasion with 110 µm (initial: 2.8 MPa; after aging: 1 MPa) than 50 µm alumina (initial: 1.4 MPa; after aging: 0 MPa). No significant effect was found between 50 and 110 µm particle size alumina in combination with the other 2 cements. After aging, the tensile strength of the crowns luted with GCM (50 µm: 0 MPa and 110 µm: 1 MPa) and ACG (50 µm: 1 MPa and 110 µm: 1.2 MPa) was significantly lower than those luted with RXU (50 µm: 1.9 MPa and 110 µm: 2 MPa). All airborne particle abraded polymeric CAD/CAM crowns (initial: 1.4-2.8; 0-2 MPa) showed significantly lower tensile strength values than the control group (initial: 7.3 MPa; after aging: 6.4 MPa). Although with all polymeric specimens, failure type was adhesive between the cement and the crowns, the control group showed exclusively cohesive failures within the ceramic. CONCLUSIONS: Airborne-particle abrasion before cementation of polymeric CAD/CAM crowns minimally improved the tensile strength. Both the failure types and the tensile strength values of adhesively luted glass ceramic crowns showed superior results to adhesively cemented polymeric ones. Although the tensile strength results were low, crowns cemented with RXU showed, after aging, the highest tensile strength of all other tested groups.

Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year results from a prospective cohort study.

OBJECTIVES: the aim of the present study was to evaluate the dimensional changes of peri-implant tissues obtained by implant placement, bone and soft tissue augmentation, prosthetic reconstruction and 1 year of function using a new, non-invasive method for volumetric measurements. MATERIALS AND METHODS: in 16 patients, the missing central or lateral maxillary incisor was reconstructed with an implant-supported single crown. Impressions were taken before (t1), after implant placement with guided bone regeneration using DBBM and a PTFE membrane (t2), after soft tissue augmentation (t3), immediately after crown placement (t4) and 1 year later (t5). The cast models were optically scanned and digitally superimposed allowing qualitative and quantitative analysis of alterations of the labial peri-implant tissue contour. In addition, the crown length and papilla height were measured at crown placement (t4) and after 1 year (t5). RESULTS: fifteen patients were available for recall after 1 year. During therapy, a mean gain in distance in the labial direction of 1.27 ± 0.67 mm was observed after the surgical procedures. One year after crown insertion, a mean loss of 0.04 ± 0.31 mm in the labial direction was recorded. During the same period, the crown length increased by a mean of 0.22 ± 0.57 mm and the papilla height by 0.07 ± 0.61 mm. The degree and pattern of tissue change following crown insertion were highly variable between individuals, irrespective of the amount and quality of previously augmented tissues. CONCLUSIONS: the clinical procedures were effective in augmenting peri-implant tissue volume that remained stable to a high degree within 1 year after crown insertion. Large inter-individual variations regarding the tissue alterations were observed.

Efficiency of a mathematical model in generating CAD/CAM-partial crowns with natural tooth morphology.

The "biogeneric tooth model" can be used for computer-aided design (CAD) of the occlusal surface of dental restorations. From digital 3D-data, it automatically retrieves a morphology matching the natural surface left after preparation. This study evaluates the potential of this method for generating well-matched and well-adjusted CAD/computer-aided manufacturing (CAM) fabricated partial crowns. Twelve models with partial crown preparations were mounted into an articulator. Partial crowns were designed with the Cerec 3D CAD software based on the biogeneric tooth model (Biog.CAD) and, for control, with a conventional data-based Cerec 3D CAD software (Conv.CAD). The design time was measured, and the naturalness of the morphology was visually assessed. The restorations were milled, cemented on the models, and the vertical discrepancy and the time for final occlusal adjustment were measured. The Biog.CAD software offered a significantly higher naturalness (up to 225 to 11 scores) and was significantly faster by 251 (± 78) s in designing partial crowns (p < 0.01) compared to Conv.CAD software. Vertical discrepancy, 0.52 (± 0.28) mm for Conv.CAD and 0.46 (± 0.19)mm for Biog.CAD, and occlusal adjustment time, 118 (± 132)s for Conv.CAD and 102 (± 77)s for Biog.CAD, did not differ significantly. In conclusion, the biogeneric tooth model is able to generate occlusal morphology of partial crowns in a fully automated process with higher naturalness compared to conventional interactive CAD software.