Displacement of Customized Abutments Designed on a Working Cast and in the Oral Cavity: A Comparative In Vivo Study.

PURPOSE: To compare abutment displacement between the virtual, customized abutment that was designed on a cast and the customized abutment prepared in the oral cavity. MATERIALS AND METHODS: Eleven patients were selected for a single posterior implant prosthetic treatment. The impression was obtained using the closed tray impression method with a vinyl polysiloxane material using a custom tray. The standard tessellation language files of the customized abutment that was designed using the computer-aided design system and acquired with an intraoral scanner in the oral cavity were superimposed and analyzed for distance and angle displacement using the three-dimensional inspection analysis program (Geomagic Control X). In the statistical analysis, distance and angle displacement values were analyzed with the Kruskal-Wallis H test (α = 0.05), and a post hoc comparison was performed using the Mann-Whitney U-test and Bonferroni correction method. RESULTS: The mean distance and angle displacement of the 15 customized abutments were 89.52 ± 66.86 µm and 0.83 ± 1.21°, respectively. There were significant differences in distance displacement (p < 0.001), and angle displacement (p < 0.001) among the 15 customized abutments, and there were no significant differences in angle displacement along the 4 directions (p = 0.735). CONCLUSIONS: The displacement values of the customized abutments evaluated in the oral cavity differed significantly from patient to patient.

Prediction of the learning curves of 2 dental CAD software programs.

STATEMENT OF PROBLEM: Dental clinical procedures are being replaced by digital workflows. Therefore, the time necessary to learn dental computer-aided design (CAD) software to achieve a change in the digital workflow should be evaluated. PURPOSE: The purpose of this study was to predict the learning curve according to the type of dental CAD software with the Wright model and to determine the rate of improvement in the learner's working time with iterative learning. MATERIAL AND METHODS: A total of 40 participants with various degrees of experience with dental computer-aided design and computer-aided manufacturing (CAD-CAM) systems were recruited. The 4 specified steps of a custom abutment design were performed with 3DSystem CAD software (Daesung) and exocad DentalCAD (exocad GmbH) software and were repeated 3 times in stages. The times were analyzed with repeated-measures 1-factor and 2-factor analyses. The learning time for 300 design iterations was estimated by applying the Wright model formula, and the 300-repetition times were analyzed with the Mann-Whitney U test (α=.05). RESULTS: exocad had a longer mean learning time than the 3DSystem. The overall change with repeated learning was significantly different (P<.001), and all differences were found in the first to third iterations. Software-dependent differences were also observed (P=.005). The Mann-Whitney U test also revealed a significant difference between the 2 software programs (P=.015), but no significant difference was found after the 56th iteration (57th iteration: P=.051). CONCLUSIONS: As the time reduction patterns for iterative learning differ depending on the type of CAD software, the learning curves may differ according to the type of software. As the operator's skill increased through iterative learning, the differences in learning times between the software programs gradually disappeared.

Accuracy of zirconia crown manufactured using stereolithography and digital light processing.

OBJECTIVES: The aim of this study is to evaluate the accuracy of zirconia crowns fabricated using stereolithography (SLA) and digital light processing (DLP) and to compare their accuracy with those fabricated using the subtractive manufacturing (SM) method. METHODS: A typodont model with a prepared maxillary first molar was scanned, and the anatomical contour crown was designed using dental computer-aided-design (CAD) software. The designed file in standard tessellation language (STL) format was used to fabricate 10 crowns per group. The crowns were manufactured using a dental milling machine (Datron D5; MLC group), SLA (CERAMAKER 900; SLAC group), and DLP (ZIPRO; DLPC group) printers. The fabricated crowns were scanned using a dental laboratory scanner and saved in three parts: the external, intaglio, and marginal surfaces. For accuracy assessment, these parts were superimposed to the reference file. Root mean square (RMS) values were evaluated using three-dimensional analysis software (Geomagic Control X). Statistical significance was evaluated using a nonparametric Kruskal-Wallis test (α = 0.05) and a post-hoc Mann-Whitney U test with Bonferroni correction (α = 0.016). RESULTS: Trueness evaluation revealed the lowest RMS value in all areas in the MLC group, followed by that in the DLPC group. The precision evaluation revealed the lowest RMS value in all areas in the MLC group. Statistically significant differences were observed among the groups in the external, intaglio, and marginal surface (P < 0.05). CONCLUSIONS: Although the restorations fabricated using SM revealed higher accuracy, the crowns manufactured using SLA and DLP methods were considered clinically acceptable. CLINICAL SIGNIFICANCE: In the production of zirconia crowns, subtractive manufacturing continues to demonstrate significantly higher accuracy compared to additive manufacturing. However, crowns fabricated using the additive manufacturing method also demonstrated high accuracy.

Trueness of stereolithography ZrO2 crowns with different build directions.

This study aims to measure the trueness of zirconia crowns with different build directions of materials fabricated using the stereolithography (SLA) method. The anatomic contour crown of prepped maxillary right first molar was designed using CAD software to obtain the standard tessellation language (STL) file. Two different build directions were set for the crowns using Materialize Magics software. One group was built with a margin base platform, while the other group was built in the direction opposite to the occlusal surface base platform. The 20 crown-shaped parts were printed. The STL files of scanned printing zirconia crowns were superimposed each segment by the 3D analysis software. The two groups were statistically analyzed using t-tests. Significant differences were found in the marginal and internal discrepancies between the groups. The build direction had a significant influence on the accuracy of the zirconia crown. The results indicate the most effective build direction for manufacturing SLA 3D-printed crowns.

Effect of Different Software Programs on the Accuracy of Dental Scanner Using Three-Dimensional Analysis.

This in vitro study aimed to evaluate the 3D analysis for complete arch, half arch, and tooth preparation region by using four analysis software programs. The CAD reference model (CRM; N = 1 per region) and CAD test models (CTMs; N = 20 per software) of complete arch, half arch, and tooth preparation were obtained by using scanners. For both CRM and CTMs, mesh data other than the same area were deleted. For 3D analysis, four analysis software programs (Geomagic control X, GOM Inspect, Cloudcompare, and Materialise 3-matic) were used in the alignment of CRM and CTMs as well as in the 3D comparison. Root mean square (RMS) was regarded as the result of the 3D comparison. One-way analysis of variance and Tukey honestly significant difference tests were performed for statistical comparison of four analysis software programs (α = 0.05). In half-arch and tooth preparation region, the four analysis software programs showed a significant difference in RMS values (p < 0.001), but in complete-arch region, no significant difference was found among the four software programs (p = 0.139). As the area of the virtual cast for 3D analysis becomes smaller, variable results are obtained depending on the software program used, and the difference in results among software programs are not considered in the 3D analysis for complete-arch region.

Comparison of clinical fit of three-unit zirconia fixed prostheses fabricated using chairside and labside CAD/CAM systems.

The purpose of this study was to assess the clinical fit provided by EZIS system, the newly commercialized chairside CAD/CAM system. Prostheses were fabricated with the chairside CAD/CAM system (CS) and labside CAD/CAM system (LS) and marginal, axial, and occlusal fit of the prostheses were compared and analyzed by using replica technique. CS group presented significantly lower fit in all the three fits compared to LS group. Differences in marginal fit, axial fit, and occlusal fit were 12.57 µm (P < 0.001), 3.32 µm (P < 0.05), and 17.20 µm (P < 0.05), respectively. Newly commercialized EZIS system yielded clinically feasible fit; however, further researches covering its biomechanical, physiological, stability aspects are required to promote active clinical use.

Comparison of Tightening Screw Accuracy of Electronic Torque Drivers.

PURPOSE: To compare the tightening torque accuracy of three electronic torque drivers. MATERIALS AND METHODS: Three electronic torque drivers were assessed using two measurement methods-pure output torque (POT) and clinical output torque (COT). For both methods, assessments were performed at set torques of 10, 20, 30, and 40 Ncm, 10 times for each setting, with each driver tested. Appropriate statistical analysis was performed according to data distribution (ie, normal vs non-normal) (α = .05). RESULTS: POT was significantly higher than COT at a set torque of 30 Ncm (P < .001). CONCLUSION: In fastening an implant screw at 30 Ncm, the operator should also consider the output torque generated in the electronic torque driver.

Accuracy evaluation of dental models manufactured by CAD/CAM milling method and 3D printing method.

PURPOSE: To evaluate the accuracy of a model made using the computer-aided design/computer-aided manufacture (CAD/CAM) milling method and 3D printing method and to confirm its applicability as a work model for dental prosthesis production. MATERIALS AND METHODS: First, a natural tooth model (ANA-4, Frasaco, Germany) was scanned using an oral scanner. The obtained scan data were then used as a CAD reference model (CRM), to produce a total of 10 models each, either using the milling method or the 3D printing method. The 20 models were then scanned using a desktop scanner and the CAD test model was formed. The accuracy of the two groups was compared using dedicated software to calculate the root mean square (RMS) value after superimposing CRM and CAD test model (CTM). RESULTS: The RMS value (152±52 µm) of the model manufactured by the milling method was significantly higher than the RMS value (52±9 µm) of the model produced by the 3D printing method. CONCLUSION: The accuracy of the 3D printing method is superior to that of the milling method, but at present, both methods are limited in their application as a work model for prosthesis manufacture.

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.

A standardization model based on image recognition for performance evaluation of an oral scanner.

PURPOSE: Accurate information is essential in dentistry. The image information of missing teeth is used in optically based medical equipment in prosthodontic treatment. To evaluate oral scanners, the standardized model was examined from cases of image recognition errors of linear discriminant analysis (LDA), and a model that combines the variables with reference to ISO 12836:2015 was designed. MATERIALS AND METHODS: The basic model was fabricated by applying 4 factors to the tooth profile (chamfer, groove, curve, and square) and the bottom surface. Photo-type and video-type scanners were used to analyze 3D images after image capture. The scans were performed several times according to the prescribed sequence to distinguish the model from the one that did not form, and the results confirmed it to be the best. RESULTS: In the case of the initial basic model, a 3D shape could not be obtained by scanning even if several shots were taken. Subsequently, the recognition rate of the image was improved with every variable factor, and the difference depends on the tooth profile and the pattern of the floor surface. CONCLUSION: Based on the recognition error of the LDA, the recognition rate decreases when the model has a similar pattern. Therefore, to obtain the accurate 3D data, the difference of each class needs to be provided when developing a standardized model.

Evaluation of shear bond strength of veneering ceramics and zirconia fabricated by the digital veneering method.

PURPOSE: The purpose of this study was to evaluate the shear bond strength (SBS) of veneering ceramic and zirconia fabricated by the digital veneering method. METHODS: A total of 50 specimens were fabricated, i.e., 10 specimens each for the metal-ceramic (control) group and the four zirconia groups. The zirconia groups comprised specimens fabricated by the digital veneering method, the heat pressing method, and hand layering method for two groups, respectively. Furthermore, the shear bond strength was measured with a universal testing machine (Model 3345, Instron, Canton, MA, USA) and statistically analyzed using one-way ANOVA set at a significance level of P<0.05. The corresponding mode of failure was determined from Scanning Electron Microscope (FESEM JSM 6701F, Jeol Ltd., Japan) observations. RESULTS: One-way analysis of variance (ANOVA) revealed that the metal-ceramic group had the highest SBS (43.62MPa), followed by the digital veneering method (28.29MPa), the heat pressing method (18.89MPa), and the layering method (18.65, 17.21MPa). The samples fabricated by digital veneering had a significantly higher SBS than the other zirconia samples (P<0.05). All of the samples exhibited mixed failure. CONCLUSIONS: Veneering ceramic with a zirconia core that was fabricated via the digital veneering method is believed to be effective in clinical use since, its shear bond strength is significantly higher than that resulting from the conventional method.

New approach to accuracy verification of 3D surface models: An analysis of point cloud coordinates.

PURPOSE: The precision of two types of surface digitization devices, i.e., a contact probe scanner and an optical scanner, and the trueness of two types of stone replicas, i.e., one without an imaging powder (SR/NP) and one with an imaging powder (SR/P), were evaluated using a computer-aided analysis. METHODS: A master die was fabricated from stainless steel. Ten impressions were taken, and ten stone replicas were prepared from Type IV stone (Fujirock EP, GC, Leuven, Belgium). The precision of two types of scanners was analyzed using the root mean square (RMS), measurement error (ME), and limits of agreement (LoA) at each coordinate. The trueness of the stone replicas was evaluated using the total deviation. A Student's t-test was applied to compare the discrepancies between the CAD-reference-models of the master die (m-CRM) and point clouds for the two types of stone replicas (α=.05). RESULTS: The RMS values for the precision were 1.58, 1.28, and 0.98µm along the x-, y-, and z-axes in the contact probe scanner and 1.97, 1.32, and 1.33µm along the x-, y-, and z-axes in the optical scanner, respectively. A comparison with m-CRM revealed a trueness of 7.10µm for SR/NP and 8.65µm for SR/P. CONCLUSIONS: The precision at each coordinate (x-, y-, and z-axes) was revealed to be higher than the one assessed in the previous method (overall offset differences). A comparison between the m-CRM and 3D surface models of the stone replicas revealed a greater dimensional change in SR/P than in SR/NP.

The effect of powder A2/powder A3 mixing ratio on color and translucency parameters of dental porcelain.

PURPOSE: The purpose of this study is to mix dental ceramic powder in varying ratios and evaluate the effect of the mixing ratio on color and translucency. MATERIALS AND METHODS: The ceramic powder of shade A3 of the same product was mixed with the shade A2 of three products: IPS e.max Ceram (Ivoclar Vivadent, Schaan, Liechtenstein), Vintage Halo (SHOFU Inc., Kyoto, Japan), and Ceramco 3 (Ceramco-Dentsply, Burlington, NJ, USA) in the following fixed ratios (0 wt%, 25 wt%, 50 wt%, 75 wt%, and 100 wt%) and then fired. A total of 150 specimen of ceramic fired were manufactured in a regular size (W: 8.5 mm, L: 10.5 mm, and H: 1.5 mm). For color and translucency, L*, a*, and b* were measured and Two-way analysis of variance (ANOVA) and One-way analysis of variance (ANOVA) were used for data analysis (α=0.05). RESULTS: The higher the mixing ratio was, L*, a*, and b* of IPS e.max Ceram were all increased, and L* of Vintage Halo was reduced and a* and b* were increased. L* and a* of Ceramco3 were reduced and b* of Ceramco3 was increased. Color difference (ΔE*ab) was increased in all three products as the mixing ratio got higher. Increased mixing ratios resulted in decreased translucency parameter (TP) values for IPS e.max Ceram but increased TP values for Vintage Halo and Ceramco3. CONCLUSION: In this limited study, CIE L*, a*, and b* were influenced by the mixing ratio of the A3 powders and porcelain powder mixtures represented a various color and translucency.

Digitization of dental alginate impression: Three-dimensional evaluation of point cloud.

The purpose of this study was to evaluate the digitization of alginate impressions by analyzing differences between the scan data of two types of impressions (alginate and rubber) taken from the master die and the scan data for the master die. The master die and impressions were digitized using a dental laser scanner (7 series, Dental Wings, Montreal, Canada). The crown portion of the abutment teeth in the digital data of 20 impressions was divided into three regions: cervical surface, middle surface, and occlusal surface. An independent t-test showed a significant difference (p<0.05) in the mean difference for each experimental group (alginate and rubber). One-way ANOVA and Tukey's honest significant difference test revealed a significant difference (p<0.05) among the three regions in the rubber impression. The results of this study also carefully suggest the possibility of digitization of alginate impressions in the future.

Accuracy evaluation of metal copings fabricated by computer-aided milling and direct metal laser sintering systems.

PURPOSE: To assess the marginal and internal gaps of the copings fabricated by computer-aided milling and direct metal laser sintering (DMLS) systems in comparison to casting method. MATERIALS AND METHODS: Ten metal copings were fabricated by casting, computer-aided milling, and DMLS. Seven mesiodistal and labiolingual positions were then measured, and each of these were divided into the categories; marginal gap (MG), cervical gap (CG), axial wall at internal gap (AG), and incisal edge at internal gap (IG). Evaluation was performed by a silicone replica technique. A digital microscope was used for measurement of silicone layer. Statistical analyses included one-way and repeated measure ANOVA to test the difference between the fabrication methods and categories of measured points (α=.05), respectively. RESULTS: The mean gap differed significantly with fabrication methods (P<.001). Casting produced the narrowest gap in each of the four measured positions, whereas CG, AG, and IG proved narrower in computer-aided milling than in DMLS. Thus, with the exception of MG, all positions exhibited a significant difference between computer-aided milling and DMLS (P<.05). CONCLUSION: Although the gap was found to vary with fabrication methods, the marginal and internal gaps of the copings fabricated by computer-aided milling and DMLS fell within the range of clinical acceptance (<120 µm). However, the statistically significant difference to conventional casting indicates that the gaps in computer-aided milling and DMLS fabricated restorations still need to be further reduced.

Evaluation of different approaches for using a laser scanner in digitization of dental impressions.

PURPOSE: This study aimed to investigate the potential clinical application of digitized silicone rubber impressions by comparing the accuracy of zirconia 3-unit fixed partial dentures (FPDs) fabricated from 2 types of data (working model and impression) obtained from a laser scanner. MATERIALS AND METHODS: Ten working models and impressions were prepared with epoxy resin and vinyl polysiloxane, respectively. Based on the data obtained from the laser scanner (D-700; 3Shape A/S, Copenhagen, Denmark), a total of 20 zirconia frameworks were prepared using a dental CAD/CAM system (DentalDesigner; 3shape A/S, Copenhagen, Denmark / Ener-mill, Dentaim, Seoul, Korea). The silicone replicas were sectioned into four pieces to evaluate the framework fit. The replicas were imaged using a digital microscope, and the fit of the reference points (P1, P2, P3, P4, P5, P6, and P7) were measured using the program in the device. Measured discrepancies were divided into 5 categories of gaps (MG, CG, AWG, AOTG, OG). Data were analyzed with Student's t-test (α=0.05), repeated measures ANOVA and two-way ANOVA (α=0.05). RESULTS: The mean gap of the zirconia framework prepared from the working models presented a narrower discrepancy than the frameworks fabricated from the impression bodies. The mean of the total gap in premolars (P=.003) and molars (P=.002) exhibited a statistical difference between two groups. CONCLUSION: The mean gap dimensions of each category showed statistically significant difference. Nonetheless, the digitized impression bodies obtained with a laser scanner were applicable to clinical settings, considering the clinically acceptable marginal fit (120 µm).