Fracture Resistance of Zirconia Restorations with Four Different Framework Designs.

Objectives: This study assessed the fracture resistance of zirconia crowns with four framework designs, fabricated by computer-aided design/computer-aided manufacturing (CAD/CAM) technology. Materials and Methods: In this experimental study, a maxillary central incisor was prepared and scanned with a CAD/CAM scanner, and 40 frameworks with 4 designs (N=10) were fabricated as follows: simple core, dentine core with a design similar to dentine, 3mm trestle design collar in the lingual aspect with proximal buttresses, and monolithic or full-contour. After porcelain applying and 20h immersion in distilled water (37°C), crowns were cemented on metal dies using zinc phosphate cement. Fracture resistance was measured by a universal testing machine. Data were analyzed with one-way ANOVA (alpha=0.05). Results: Fracture resistance was maximum in the monolithic group, followed by the dentine core, trestle design, and simple core groups, respectively. The mean fracture resistance of the monolithic group was significantly higher than that of the simple core group (P<0.005). Conclusion: Zirconia restorations with frameworks that provided higher and more support for porcelain, showed increased fracture resistance.

Evaluation of the effect of milling mode and margin definition on adaptation of chairside digitally designed and fabricated ceramic veneers.

AIM: The present study aimed to evaluate the effect of the milling mode and margin defining method on the marginal and internal adaptation of digitally designed and fabricated ceramic veneers. MATERIALS AND METHODS: Forty extracted central incisors were prepared for ceramic veneers. The veneers were categorized into four groups (n = 10) based on the milling mode (fine or extra-fine) and design (automatic or manual defining of cervical and incisal margins). The veneers were cemented to the teeth using resin cement and then polished. After cementation, the teeth were embedded in clear polyester resin, then cut into three sections. Absolute marginal gap at the cervical margins (AMGC), marginal gap at the incisal (MGI) and cervical (MGC) margins, and internal gap (IG) at the axial wall were evaluated using a scanning electron microscope. Two-way analysis of variance (ANOVA) and t tests were used (α = 0.05) for the statistical analysis. RESULTS: The margin defining method affected the adaptation of the internal and incisal margin; the automatic (software) margin defining method resulted in a smaller MGI (P = 0.038) and IG (P = 0.009) than the manual defining method. CONCLUSION: The type of milling mode did not affect the marginal gap. The margin defining method affected the marginal gap at the incisal margin and the internal gaps. (Int J Comput Dent 2022;25(3):277-285; doi: 10.3290/j.ijcd.b2588153).

Evaluating the effect of repeated use of milling burs on surface roughness and adaptation of digitally fabricated ceramic veneers.

OBJECTIVES: This study aimed to evaluate how repeated use of milling diamond burs with different coarseness affects surface roughness, and marginal and internal adaptation of CAD/CAM veneers. METHODS: Forty leucite-reinforced glass-ceramic veneers were milled in 2 groups based on the milling mode (with fine or extra-fine bur sets). In each group, every 10 veneers were milled with a new bur set. All veneers were cemented to bovine teeth and then polished. Labial surface roughness was measured before cementation, and after polishing. Marginal and internal discrepancies were measured using a field emission scanning electron microscope. Three-way and two-way mixed repeated measures ANOVA were applied to assess changes in surface roughness values of veneers and discrepancy values, respectively. The Bonferroni correction was applied for multiple comparisons. RESULTS: Repeated use of a milling diamond bur set had a significant effect on surface roughness of the veneers (P < .001). Mean surface roughness of the fine milling mode was significantly higher in comparison to that of extra-fine mode before (P = .002) and after (P = .01) polishing. After polishing a significant decrease in surface roughness occurred in fine (P = .02), but not in extra-fine milling mode (P = .99). Repeated use of milling burs significantly affected marginal and internal adaptation between some repeated uses. CONCLUSIONS: Marginal and internal adaptation were significantly affected by repeated use of milling diamond burs up to 10 times between some repeated uses. However, no specific pattern could be established. CLINICAL SIGNIFICANCE: Repeated use of milling burs could affect surface roughness, surface microcracks, critical defects, and adaptation of CAD/CAM restorations. Therefore, it plays a major role in clinical success of the restorations.

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

PURPOSE: This study compared digital (reference point matching) and replica methods for measuring marginal and internal fit of full coverage restorations. MATERIALS AND METHODS: A maxillary left first molar typodent was fixed on to an aluminum base and prepared to receive all-ceramic full coverage restoration. The model was scanned with an intraoral scanner (CEREC Omnicam, Sirona, York, PA, USA). Twelve crowns were fabricated from lithium disilicate blocks (IPS emax CAD, Ivoclar Vivadent) and then crystalized. Marginal and internal fit of each restoration was measured by two examiners using replica and a new digital three-dimensional technique. Reliability between the two methods and two examiners was assessed by correlation and Cronbach's Alpha coefficient (P<.05). A Bland-Altman assessment for agreement was used to compare the two methods. RESULTS: Bland-Altman assessment showed that the mean of difference for marginal, absolute marginal, and axial gap was respectively -1.04 µm, -41.9 µm, and -29.53 µm with limit of agreement (LOA) between -37.26 to 35.18 µm for marginal, -105.85 to 22.05 µm for absolute marginal and -80.52 to 22.02 µm for axial gap. Positive correlation for repeatability (P<.05) in determining marginal and internal gaps by the two examiners in both techniques was revealed. Reliability of both techniques in all sites of measurements was at least good (0.8 ≤ α < 0.9). CONCLUSION: Both measuring techniques appeared highly reliable for evaluating fit of fixed dental restorations, while reference point matching provided higher values in axial and absolute marginal gap assessment.

A clinical comparison of digital and conventional impression techniques regarding finish line locations and impression time.

OBJECTIVE: This study compared digital and conventional impression techniques regarding impression time, frequency of adjustments, and adaptation of cobalt-chromium (Co-Cr) copings with supragingival and subgingival finish lines. MATERIALS AND METHODS: Thirty premolars prepared for single-unit metal-ceramic restorations with supragingival and subgingival finish lines (n = 15). Conventional impression and digital scan of prepared teeth were made. Using computer aided design/computer aided manufacturing (CAD/CAM) system the copings were produced by a milling machine from Co-Cr blocks and internal and marginal discrepancies were measured using silicone replica technique. Data were analyzed using repeated measures ANOVA and Mann-Whitney test (alpha = .05). RESULTS: The impression technique had a significant effect on the magnitude of gap (P < .001). The internal and marginal gaps in the digital technique (49.43 µ and 60.07 µ, respectively) were significantly lower than the values in the conventional method (91.88 µ and 96.96 µ, respectively-P < .001). Finish line positions had no significant effect on the fit and marginal gap of copings (P = .54 and .243, respectively). The mean impression time (19':27″ in conventional technique and 10':31″ in digital technique) was significantly shorter (P < .001) and the mean frequency of adjustments (2.2 times for conventional and 1.3 times for digital technique) was significantly lower in the digital technique (P < .001). The gingival biotype (thick or thin) had no significant effect on marginal and internal fit (P = .052 and .319, respectively). CONCLUSION: The digital technique was superior in terms of fit, impression time, and frequency of adjustments. Finish line positions had no significant effect on the fit of copings. CLINICAL SIGNIFICANCE: Using intraoral scanner promotes the fits of restorations in supragingival and subgingival finish lines.