CAD/CAM full-mouth rehabilitation of an elderly patient: One-piece digital complete denture meets multilayered zirconia with gradient technology.

OBJECTIVE: This article highlights a CAD/CAM complete-mouth rehabilitation in an 82-year-old patient by means of a complete maxillary prosthesis and mandibular implant- and tooth-supported fixed restorations made from multilayered zirconia. CLINICAL CONSIDERATIONS: Comprehensive complete-mouth rehabilitations in elderly patients with adaptation of the occlusal vertical dimension (OVD) often present particular challenges. This applies especially when exacting functional and esthetic requirements are to be met and the treatment should not cause the patient too much effort, still ensuring the highest level of quality and efficiency and a low intervention rate. CONCLUSION: The digital approach used for the present patient allowed for an efficient treatment procedure, facilitated virtual evaluations using a face-scan, and enhanced the predictability of the prosthodontic outcome. The approach enabled some steps required in the conventional protocol to be omitted, resulting in a straightforward clinical treatment with minimal strain on the patient. CLINICAL SIGNIFICANCE: Because of the comprehensive recording of extraoral and intraoral data, for example with a facial scanner, it was possible to transfer a digital replica of the patient to the dental laboratory technician. With this protocol, many steps can be performed in the absence of the real patient.

Clinical performance of monolithic lithium disilicate hybrid abutment crowns over at least 3.5 years.

PURPOSE: Hybrid abutment crowns (HACs) made from monolithic ceramics represent an efficient option for single restorations on implants. However, long-term data are scarce. The purpose of this clinical trial was to evaluate the survival and complication rates of CAD-CAM fabricated HACs over a time period of at least 3.5 years. MATERIALS AND METHODS: Twenty-five patients with a total of 40 HACs made of monolithic lithium disilicate ceramic bonded to a titanium base CAD-CAM abutment were retrospectively evaluated. All implants and screw-retained restorations were placed and manufactured in the same department of a university hospital. Only crowns that had been in service for more than 3.5 years were included in the study. HACs were evaluated regarding technical and biological complications. Functional Implant Prosthodontic Scores (FIPS) were obtained. RESULTS: The mean observation time was 5.9 ± 1.4 years. Implant survival was 100%, and HAC survival was 97.5%. Over the observation period, one crown fracture was observed, necessitating refabricating of the restoration. Three minor biological complications were found. The overall mean FIPS score was 8.69 ± 1.12 points. CONCLUSIONS: Within the limitations of this study, monolithic screw-retained HACs milled from lithium disilicate ceramics and bonded to titanium bases appeared to be a reliable treatment option over more than 3.5 years due to their low biological and technical complication rates.

In Vitro Survival and Fracture Force of Lithium-Disilicate Hybrid Abutment Crowns.

PURPOSE: To evaluate the behavior of hybrid abutment crowns fabricated from monolithic lithium disilicate ceramic (LDC) and to compare the influence of different in-vitro artificial aging protocols. MATERIAL AND METHODS: 32 monolithic hybrid abutment crowns of monolithic LDC were fabricated. 24 were artificially aged applying 3 different protocols up to a 20 year-simulation (1.2 × 106, 2.4 × 106, 4.8 × 106 chewing cycles, thermocycling), one control group underwent no artificial aging (N=32, n=8). Load-to-failure tests were conducted for all specimens and failure values were compared (p<0.05). RESULTS/CONCLUSIONS: All specimens passed in-vitro aging. Mean failure load values between 532.6 and 562.8 N were found but did neither differ significantly among the test groups nor from the control group. Within the limitations of this in-vitro pilot study, hybrid abutment crowns manufactured from monolithic LDC seem to offer appropriate long-lasting mechanical stability over a simulation period up to 20 years. The failure values and complication pattern seem to be independent of several aging protocols in this test set-up.

Biomechanical behavior of implants with different diameters in relation to simulated bone loss- an in vitro study.

OBJECTIVES: Bone resorption around implants could influence the resistance of the implant abutment complex (IAC). The present in vitro study aimed to assess the stability to static fatigue of implants presenting different levels of bone losses and diameters. MATERIALS AND METHODS: Ninety implants with an internal conical connection with 3 different implant diameters (3.3 mm (I33), 3.8 mm (I38), and 4.3 mm (I43)) and 3 simulated bone loss settings (1.5 mm (I_15), 3.0 mm (I_30), and 4.5 mm (I_45) (n = 10)) were embedded and standard abutments were mounted. All specimens were artificially aged (1,200,000 cycles, 50 N, simultaneous thermocycling) and underwent subsequently load-to-fracture test. For statistical analysis, Kolmogorov-Smirnov test, Kruskal-Wallis test, and Mann-Whitney U test (p < 0.05) were applied. RESULTS: All test specimens withstood the artificial aging without damage. The mean failure values were 382.1 (± 59.2) N (I3315), 347.0 (± 35.7) N (I3330), 315.9 N (± 30.9) (I3345), 531.4 (± 36.2) N (I3815), 514.5 (± 40.8) N (I3830), 477.9 (± 26.3) N (I3845), 710.1 (± 38.2) N (I4315), 697.9 (± 65.2) N (I4330), and 662.2 N (± 45.9) (I4345). The stability of the IACs decreased in all groups when bone loss inclined. Merely, the failure load values did not significantly differ among subgroups of I43. CONCLUSIONS: Larger implant diameters and minor circular bone loss around the implant lead to a higher stability of the IAC. The smaller the implant diameter was, the more the stability was affected by the circumferential bone level. CLINICAL RELEVANCE: Preserving crestal bone level is important to ensure biomechanical sustainability at implant systems with a conical interface. It seems sensible to take the effect of eventual bone loss around implants into account during implant planning processes and restorative considerations.

Digital jaw relation recording to evaluate a new vertical dimension of occlusion using CAD/CAM-fabricated tooth-colored splints: a case report.

Pronounced defects of the dental hard tissue can be caused by different etiologic factors. Most frequently, they are associated with changes in the vertical dimension of occlusion (VDO), which may also influence the condylar positions. These defects can lead to irreversible loss of tooth structure and have dramatic functional and esthetic consequences, often requiring complex rehabilitation. In this situation, CAD/CAM-fabricated occlusal splints made of tooth-colored polycarbonate are a proven and safe pretreatment approach in terms of esthetics and function. Rebuilding lost dental hard tissue to restore the occlusion and VDO to an adequate condylar position is a prerequisite for any sustainable and functional rehabilitation. In the future, digital systems will support this complex process, customizing it and making it simpler and more precise. The DMD-System (Ignident) provides patient-specific jaw movement data to optimize the CAD/CAM workflow. This system allows real movement patterns to be digitized and analyzed for functional and potential therapeutic purposes, integrating them into the dental and laboratory workflow. In the present case, the familiar tooth-colored CAD/CAM-fabricated occlusal splint is supplemented by digital centric jaw relation recording and individual movement data.

The Fracture Load as a Function of the Material Thickness: The Key to Computing the Strength of Monolithic All-Ceramic Materials?

The thickness of a material has a significant impact on its fracture load. The aim of the study was to find and describe a mathematical relationship between the material thickness and the fracture load for dental all-ceramics. In total, 180 specimens were prepared from a leucite silicate ceramic (ESS), a lithium disilicate ceramic (EMX), and a 3Y-TZP zirconia ceramic (LP) in five thicknesses (0.4, 0.7, 1.0, 1.3, and 1.6 mm; n = 12). The fracture load of all specimens was determined using the biaxial bending test according to the DIN EN ISO 6872. The regression analyses for the linear, quadratic, and cubic curve characteristics of the materials were conducted, and the cubic regression curves showed the best correlation (coefficients of determination (R2): ESS R2 = 0.974, EMX R2 = 0.947, LP R2 = 0.969) for the fracture load values as a function of the material thickness. A cubic relationship could be described for the materials investigated. Applying the cubic function and material-specific fracture-load coefficients, the respective fracture load values can be calculated for the individual material thicknesses. These results help to improve and objectify the estimation of the fracture loads of restorations, to enable a more patient- and indication-centered situation-dependent material choice.

Predictable esthetics in hybrid and resin-based CAD/CAM restorative materials: Translucency as a function of material thickness.

AIM: The CAM of esthetically pleasing monolithic dental restorations presents with specific challenges. One vital parameter to consider is the translucency of the materials. Previous studies have proven a correlation between translucency and material thickness for various all-ceramic materials. The aim of the present study was to assess and define the relationship between thickness and translucency in modern resin-based restorative materials. MATERIALS AND METHODS: Specimens fabricated from two resin nano-ceramics (Cerasmart, Lava Ultimate), a polymer-infiltrated ceramic network (Vita Enamic), and a polymethyl methacrylate (Telio CAD) were examined, representing these different material classes. For each material, 12 specimens (n = 12) were fabricated in five thicknesses (0.4, 0.7, 1.0, 1.3, and 1.6 mm; N = 240). The translucency was measured with a spectrophotometer. The total light transmittance for each specimen was calculated applying specialized software. Regression curves were fitted to the results and their coefficient of determination (R2) fit was determined. RESULTS: Logarithmic regression curves showed the best R2 approximation (Cerasmart: R2 = 0.994; Vita Enamic: R2 = 0.978; Lava Ultimate: R2 = 0.997; Telio CAD: R2 = 0.997) to the light transmission values. CONCLUSIONS: The results of the present study indicate that the translucency of resin-based materials can be calculated using a mathematic approach to estimate their optical behavior. Cerasmart, Lava Ultimate, Vita Enamic, and Telio CAD exhibit a logarithmic relationship between material thickness and translucency. By determining material-specific coefficients for this logarithmic function, the resulting translucency can be computed for any given material thickness.

Influence of monolithic restorative materials on the implant-abutment interface of hybrid abutment crowns: An in vitro investigation.

Purpose This in vitro study aimed to investigate the long-term performance, stability, and fracture mode of monolithic hybrid abutment crowns, and the effect of different materials on the implant-abutment interface (IAI).Methods Eighty monolithic hybrid abutment crowns luted on titanium bases were manufactured from 3Y-TZP zirconia (ZY3), "Gradient Technology" zirconia (ZY35), 5Y-TZP zirconia (ZY5), lithium disilicate ceramic (LDS), zirconia-reinforced lithium silicate ceramic (ZLS), polymer-infiltrated ceramic network (MHY), polymethylmethacrylate (PMA), and 3D-printed hybrid composite (PHC) (n = 10 for each material). Eighty implants (Camlog Progressive-Line, diameter: 3.8 mm) were embedded in accordance with ISO standard 14801, and crowns were mounted. After artificial aging (1.2 × 106 cycles, 50 N, thermocycling), intact specimens were loaded 30° off-axis in a universal testing machine until failure.Results Seven specimens in the PHC group failed during artificial aging, and all the others survived. There were two subgroups based on the one-way analysis of variance and Dunnett's test (P < 0.05) of the mean fracture load values. The first comprised Z3Y, ZY35, Z5Y, and LDS, with mean fracture loads between 499.4 and 529.7 N, while the second included ZLS, MHY, and PMA, with values in the 346.2-416.0 N range. ZY3, ZY35, ZY5, and LDS exhibited irreversible, visible deformations of the implant shoulders with varying dimensions after load-to-fracture tests.Conclusions Crowns made of LDS, ZLS, MHY, and PMA may act as potential stress breakers, and prevent possible deformation at IAIs. Further clinical studies need to assess if these materials also withstand relevant loads in-vivo.

Atraumatic intraoral scans and virtual hybrid casts for custom implant abutments and zirconia implants: Accuracy of the workflow.

STATEMENT OF PROBLEM: Making impressions of 2-piece implants is typically associated with the repeated disassembly and reassembly of superstructures and related to soft-tissue trauma. Intraoral scanning of 1-piece zirconia implants is problematic because scan bodies are not readily available. Whether using virtual hybrid casts generated by merging intraoral scan data with the known surface geometry of abutments can solve these difficulties is not clear because data on accuracy of the workflow are sparse. PURPOSE: The purpose of this in vitro study was to evaluate the accuracy of virtual hybrid casts with respect to the impact of different gingival situations. The workflow was designed to render pointless the use of impression posts and scan bodies and avoid any displacement of the gingiva. MATERIAL AND METHODS: The mandibular right first molar in a typodont was replaced with a 2-piece titanium implant with a custom abutment and then a 1-piece zirconia implant. Three situations representing different gingival heights covering the abutments were simulated. Twelve intraoral scans were made for each situation to capture the recordable parts of the abutments, and virtual hybrid casts were constructed by superimposing and merging the intraoral scan data with the original laboratory scan data of the abutments. Hybrid casts were compared with reference data by using the root mean square error. Scan body-related and cast scan-related protocols were performed representing conventional digital workflows. Statistical analysis with the Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests with the Bonferroni correction was conducted with a statistical software program (α=.05). RESULTS: Deviation was low in the hybrid casts of the custom abutment when the entire abutment was recorded (6.5 µm; IQR: 3.0 µm), when the preparation margin was disguised (7.0 µm; IQR: 1.0 µm), and when half of the abutment was covered (8.0 µm; IQR: 4.0 µm). The accuracy in the 1-piece zirconia implant was 10.0 µm (IQR: 4.0 µm) when the whole surface of the abutment was visible and 12.5 µm (IQR: 6.0 µm) when the preparation margin was covered. When only half of the abutment was captured, a larger deviation of 22.0 µm (IQR: 7.0 µm) was observed. The hybrid cast concept demonstrated superior accuracy compared with protocols using scan bodies (76.0 µm; IQR: 27.0 µm) and cast scans (23.0 µm; IQR: 15.0 µm). CONCLUSIONS: Digital intraoral scanning and the generation of virtual hybrid casts provide high accuracy and are suitable for the fabrication of single-implant-supported restorations. The atraumatic procedure avoids tissue manipulation and reduces clinical effort.

Influence of Pre-Treatment and Artificial Aging on the Retention of 3D-Printed Permanent Composite Crowns.

The aim of this in vitro study is to investigate the bonding properties of a 3D-printable permanent composite material in comparison to milled composite materials. The tested materials are 3D-printed BEGO VarseoSmile Crown plus (VA1_ab, VA1_nt, VA2_ab, VA2_nt), Vita Enamic (EN1, EN2), and 3M Lava Ultimate (UL1, UL2) (N = 64; n = 8). For this purpose, all crowns are luted to polymer tooth stumps #46 (FDI) using dual-curing luting composite, strictly according to the manufacturer's instructions. VA1_ab and VA2_ab are additionally airborne-particle abraded. 4 groups (VA2_ab, VA2_nt, EN2, UL2) are artificially aged (1,200,000 cycles, 50 N, 10,000 thermocycles), whereby no specimen has failed. All 64 specimens undergo pull-off testing until retention loss. The mean forces of retention-loss is 786.6 ± 137.6 N (VA1_nt, *), 988.6 ± 212.1 N (VA2_nt, *, Ɨ), 1223.8 ± 119.2 N (VA1_ab, Ɨ, ǂ), 1051.9 ± 107.2 N (VA2_ab, *, Ɨ), 1185.9 ± 211.8 N (EN1, Ɨ, ǂ), 1485.0 ± 198.2 N EN2, ǂ), 1533.8 ± 42.4 N (UL1, ǂ), and 1521.8 ± 343.4 N (UL2, ǂ) (one-way ANOVA (Scheffé method); p < 0.05; *, Ɨ, ǂ: group distribution). No characteristic failure modes can be detected. In conclusion, all of the pull-off forces reflect retention values that seem to be sufficiently high for clinical use. Additional airborne-particle abrasion of VA does not result in significantly better retention but can be recommended.

Digital Veneering Techniques for Zirconia Implant-Supported Single Crowns-Bond Strength and Clinical Application.

PURPOSE: To evaluate the shear bond strength (SBS) of different digital veneering techniques for zirconia and to critically discuss its suitability for application in single-implant prosthetics. MATERIALS AND METHODS: A total of 112 square-shaped zirconia specimens were provided with four different veneering materials (n = 28 per group): a glass-ceramic (group GLA), a feldspathic ceramic (group FEL), a polymer-infiltrated ceramic network (group PIC), and a resin nanoceramic (group RNC). Discs in group GLA were sintered onto the core material, whereas all other specimens were adhesively connected. In each group, 14 specimens (GLA0, FEL0, PIC0, RNC0) were subjected to SBS testing before thermocycling, and the other 14 (GLA1, FEL1, PIC1, RNC1) were tested after thermocycling (10,000 cycles). Data were analyzed by applying SPSS software (P < .05). The surfaces and fracture patterns of the specimens were examined using scanning electron microscopy (SEM). RESULTS: Mean SBS values ranged from 14.09 ± 3.87 MPa (RNC1) to 40.82 ± 4.91 MPa (GLA0). Group GLA presented higher values than all other groups (P < .001). Groups FEL, PIC, and RNC showed no statistically significant differences between them. SBS decreased after thermocycling, but no significant impact was found. Every group exhibited a characteristic failure mode. CONCLUSION: All digital veneering techniques sufficed to present clinically acceptable SBS values and might be viable alternatives in implant prosthetics. However, some have yet to demonstrate their long-term clinical suitability. At present, lithium disilicate-veneered zirconia abutments and monolithic lithium disilicate hybrid abutment crowns seem to present a proven and reliable restorative option.

Application of 3D-printed colored 3D-models for the fabrication of full ceramic restorations: A technical report.

OBJECTIVE: This paper presents a novel digital workflow that expedites and facilitates the manufacturing of high-end full-ceramic restorations based on "Print and Press"-Technology combined with 3D-printed colored 3D-models. CLINICAL CONSIDERATIONS: Despite ongoing innovations and developments in the digital workflow, the precision, and the final esthetic outcome is still limited compared with conventional press ceramics. The proposed method combines the advantages of digital scan- and design technologies with the proven conventional press-technology to accomplish high-end full-ceramic restorations. The restoration is digitally designed, the data set is 3D-printed in resin that can be burned out, subsequently conventionally embedded and pressed. Final esthetic finishing of the partial restorations is done on a 3D-printed physical colored 3D-model. CONCLUSION: The report describes synergetic effects of digital and analog procedures. 3D-printed colored 3D-models can positively support the manufacturing of full ceramic restorations regarding their optical integration. Therefore, the use of 3D-printed colored 3D-models signifies a new innovative technique with many promising application areas. CLINICAL SIGNIFICANCE: The combination of excellent clinical long-term data for pressed ceramic restorations and proven digital processes, like intraoral scanning, design, and additive manufacturing, in the dental field promise an individual workflow for predictability and excellent esthetics.

Short communication: In vitro pilot study: Are monolithic 3Y-TZP zirconia crowns too strong for titanium Implants?

PURPOSE: To report on pilot tests for a planned study on single implant-supported crowns made from different restorative materials using finite element analysis (FEA) and in vitro load-to-failure testing. MATERIALS AND METHODS: Within this pilot study, FEA was conducted using Ansys 2019 R2 to simulate stress and deformation for implant-supported crowns made of lithium disilicate ceramic (LiS2) and zirconia (3Y-TZP). Additionally, an in vitro load to failure test was conducted using two specimens per group to evaluate the failure mode and to confirm the findings from the FEA. RESULTS/CONCLUSION: FEA revealed stress areas at the palatal cervical areas of the crowns. In the load to failure test, both hybrid abutment crowns made of LiS2 fractured (410 N and 510 N) before plastic deformation of the metal implant components occurred. The monolithic hybrid abutment crowns made of 3Y-TZP did not fracture until tests were interrupted at 646-N and 690-N occlusal force, when plastic deformation of the metal implant components was visually observed.

CAD/CAM-milled versus conventionally cast secondary crowns fabricated from high noble metal alloy: an in vitro study of retentive force.

AIM: To investigate retentive forces (RFs) of CAD/CAM-milled and conventionally cast secondary crowns (SCs) after artificial aging in an in vitro study. MATERIALS AND METHODS: Forty artificial premolars were manufactured and provided with 40 primary crowns (PCs) milled from a high noble metal alloy. SCs were fabricated from the same alloy. Ten SCs were produced with the help of a tactile scanning method (group A), 10 with the help of a photo-optical scan (spray; group B), 10 with the help of a photo-optical scan (acrylic dye; group C), and 10 using a conventional casting technique (group D). Cycles of separation were performed and RFs were measured at baseline and after 5,000 and 10,000 cycles. Surfaces were examined under a scanning electron microscope (SEM). Statistical analysis was conducted at a significance level of P ≤ 0.05. RESULTS: Group D showed the highest median RFs with respective interquartile ranges (IQRs) - baseline: 7.0(2.5) N; 5,000 cycles: 5.5(2.0) N; 10,000 cycles: 5.4(1.5) N compared with groups A, B, and C - baseline: 5.2(8.4)/3.4(11.3)/1.3(1.5) N; 5,000 cycles: 1.8(0.8)/2.1(1.7)/1.0(1.3) N; 10,000 cycles: 1.9(1.6)/2.4(2.5)/1.0(1.4) N, respectively. In contrast to groups A, B, and C, group D did not gain RF when RF values were compared after 5,000 and 10,000 cycles. The loss of RF between baseline (7.0 N) and after 10,000 cycles (5.4 N) was significant only for group D (P = 0.007), but not for groups A, B, and C. CONCLUSION: Both CAD/CAM-milled and conventionally cast SCs from a high noble metal alloy can provide sufficient RF after 10,000 cycles of artificial aging. However, groups A, B, and C showed constantly lower RF values compared with group D.

Release of Bisphenol A from Milled and 3D-Printed Dental Polycarbonate Materials.

Polycarbonates are polymers of bisphenol A (BPA), a well-known endocrine disruptor. This study evaluated the release of BPA from polycarbonate crowns that were (1) milled from Temp Premium Flexible (ZPF, Zirkonzahn, Italy) or Tizian Blank Polycarbonate (TBP, Schütz Dental, Germany), or (2) 3D-printed (Makrolon 2805, Covestro, Germany). Commercial prefabricated polycarbonate crowns (3M, USA) and milled poly(methyl methacrylate) (PMMA) crowns (Temp Basic, Zirkonzahn, Italy) were included for comparison. The crowns were stored at 37 °C in artificial saliva (AS) or methanol, which represented the worst-case scenario of BPA release. Extracts were collected after 1 day, 1 week, 1 month and 3 months. BPA concentrations were measured using liquid chromatography-tandem mass spectrometry. The amounts of released BPA were expressed in micrograms per gram of material (µg/g). After 1 day, the highest amounts of BPA were measured from milled polycarbonates, TBP (methanol: 32.2 ± 3.8 µg/g, AS: 7.1 ± 0.9 µg/g) and ZPF (methanol 22.8 ± 7.7 µg/g, AS: 0.3 ± 0.03 µg/g), followed by 3D-printed crowns (methanol: 11.1 ± 2.3 µg/g, AS: 0.1 ± 0.1 µg/g) and prefabricated crowns (methanol: 8.0 ± 1.6 µg/g, AS: 0.07 ± 0.02 µg/g). Between 1 week and 3 months, the average daily release of BPA in methanol and AS decreased below 2 µg/g and 0.6 µg/g, respectively. No BPA was released from PMMA in AS, and the cumulative amount released in methanol was 0.2 ± 0.06 µg/g. In conclusion, polycarbonates could be a relevant source of BPA, but the current tolerable daily intake of BPA (4 µg/kg body weight) should not be exceeded.

In-vivo-wear in composite and ceramic full mouth rehabilitations over 3 years.

The aim of this study was to quantify and to compare the wear rates of premolar (PM) and molar (M) restorations of lithium disilicate ceramic (LS2) and an experimental CAD/CAM polymer (COMP) in cases of complex rehabilitations with changes in vertical dimension of occlusion (VDO). Twelve patients with severe tooth wear underwent prosthetic rehabilitation, restoring the VDO with antagonistic occlusal coverage restorations either out of LS2 (n = 6 patients, n = 16 posterior restorations/patient; N = 96 restorations/year) or COMP (n = 6 patients; n = 16 posterior restorations/patient; N = 96 restorations/year). Data was obtained by digitalization of plaster casts with a laboratory scanner at annual recalls (350 ± 86 days; 755 ± 92 days; 1102 ± 97 days). Each annual recall dataset of premolar and molar restorations (N = 192) was overlaid individually with the corresponding baseline dataset using an iterative best-fit method. Mean vertical loss of the occlusal contact areas (OCAs) was calculated for each restoration and recall time. For LS2 restorations, the mean wear rate per month over 1 year was 7.5 ± 3.4 µm (PM), 7.8 ± 2.0 µm (M), over 2 years 3.8 ± 1.6 µm (PM), 4.4 ± 1.5 µm (M), over 3 years 2.8 ± 1.3 µm (PM), 3.4 ± 1.7 µm (M). For COMP restorations, the mean wear rate per month over 1 year was 15.5 ± 8.9 µm (PM), 28.5 ± 20.2 µm (M), over 2 years 9.2 ± 5.9 µm (PM), 16.7 ± 14.9 µm (M), over 3 years 8.6 ± 5.3 µm (PM), 9.5 ± 8.0 µm (M). Three COMP restorations fractured after two years and therefore were not considered in the 3-year results. The wear rates in the LS2 group showed significant differences between premolars and molars restorations (p = 0.041; p = 0.023; p = 0.045). The wear rates in COMP group differed significantly between premolars and molars only in the first two years (p < 0.0001; p = 0.007). COMP restorations show much higher wear rates compared to LS2. The presented results suggest that with increasing time in situ, the monthly wear rates for both materials decreased over time. On the basis of this limited dataset, both LS2 and COMP restorations show reasonable clinical wear rates after 3 years follow-up. Wear of COMP restorations was higher, however prosthodontic treatment was less invasive. LS2 showed less wear, yet tooth preparation was necessary. Clinicians should balance well between necessary preparation invasiveness and long-term occlusal stability in patients with worn dentitions.

Innovative tooth-colored CAD/CAM polycarbonate splint design for prosthetic rehabilitation of a young ectodermal dysplasia patient with permanent tooth aplasia.

Ectodermal dysplasia (ED) is one of the congenitally syndromic diseases with dental anomalies. This syndrome manifests in various forms and usually requires early restorative therapy to restore esthetics and function in young patients. The restorative approaches vary greatly and range from minimally invasive shape corrections using composite build-ups and removable partial or complete dental prostheses, to implantologic solutions, always based on the syndromic expression, the age of the patient, the residual growth, as well as the dentition itself. The present case report presents an innovative prosthetic management of a young patient suffering from ED with permanent tooth aplasia and persistent primary teeth using maxillomandibular individually veneered tooth-colored CAD/CAM polycarbonate splints. The CAD phase has been significantly improved by including the analysis of 3D face scans. This advanced technical development makes it possible to avoid any time-consuming try-in and start directly with the splint production, ensuring a much faster complete rehabilitation and support for the young patient.

3D Printing in Digital Prosthetic Dentistry: An Overview of Recent Developments in Additive Manufacturing.

Popular media now often present 3D printing as a widely employed technology for the production of dental prostheses. This article aims to show, based on factual information, to what extent 3D printing can be used in dental laboratories and dental practices at present. It attempts to present a rational evaluation of todays´ applications of 3D printing technology in the context of dental restorations. In addition, the article discusses future perspectives and examines the ongoing viability of traditional dental laboratory services and manufacturing processes. It also shows which expertise is needed for the digital additive manufacturing of dental restorations.

Predictable esthetics in all-ceramic restorations: Translucency as a function of material thickness.

BACKGROUND: The esthetic outcome of a dental restoration largely depends on the translucency of the materials used, especially for monolithic restorations. Research has been published reporting a correlation between translucency and material thickness. However, no mathematical formula has been described yet. The aim of the present study was to determine the mathematical relationship between material thickness and translucency of three dental ceramic materials. MATERIAL AND METHODS: Three representative all-ceramic materials were taken out of the group of silicate ceramics (IPS Empress CAD LT), lithium X-silicate ceramics (IPS e.max CAD LT), and oxide ceramics (Lava Plus HT). Sixty specimens with five different thicknesses (0.4, 0.7, 1.0, 1.3, and 1.6 mm; N = 60, n = 12) were produced out of each ceramic (N = 180). A spectrophotometer was used to measure the transmittance coefficient tc[%] for each wavelength within the visible light spectrum, and the total light transmittance (T%) was calculated for each specimen. Linear, exponential, and logarithmic regression curves were fitted to the results. RESULTS: The logarithmic regression curves exhibited the best correlation (R2; IPS Empress CAD LT, R2 = 0.996; IPS e.max CAD LT, R2 = 0.987; Lava Plus HT, R2 = 0.907) to the transmittance values. CONCLUSION: Within the limitations of the present study, the transmittance behavior of silicate ceramics, lithium-X-silicate ceramics, and oxide ceramics can be described by a logarithmic equation. The findings of this study therefore suggest that the optical behavior might be calculable by a mathematical approach.

Elution behavior of a 3D-printed, milled and conventional resin-based occlusal splint material.

OBJECTIVE: The elution of unpolymerized (co-)monomers and additives from methacrylic resin-based materials like polymethyl methacrylate (PMMA) can cause adverse side effects, such as mutagenicity, teratogenicity, genotoxicity, cytotoxicity and estrogenic activity. The aim of this study was to quantify the release and the cytotoxicity of residual (co-)monomers and additives from PMMA-based splint materials under consideration of real splint sizes. Three different materials used for additive (3D printing), subtractive (milling) and conventional (powder and liquid) manufacturing were examined. METHODS: The splint materials SHERAprint-ortho plus (additive), SHERAeco-disc PM20 (subtractive) and SHERAORTHOMER (conventional) were analysed. 16 (n = 4) sample discs of each material (6 mm diameter and 2 mm height) were polished on the circular and one cross-section area and then eluted in both distilled water and methanol. The discs were incubated at 37 °C for 24 h or 72 h and subsequently analysed by gas chromatography/mass spectrometry (GC/MS) for specifying and quantifying released compounds. XTT-based cell viability assays with human gingival fibroblasts (HGFs) were performed for Tetrahydrofurfuryl methacrylate (THFMA), 1,4-Butylene glycol dimethacrylate (BDDMA) and Tripropylenglycol diacrylate (TPGDA). In order to project the disc size to actual splint sizes in a worst-case scenario, lower and upper jaw occlusal splints were designed and volumes and surfaces were measured. RESULTS: For SHERAeco-disc PM20 and for SHERAORTHOMER no elution was determined in water. SHERAprint-ortho plus eluted the highest THFMA concentration of 7.47 µmol/l ±2,77 µmol/l after 72 h in water. Six (co-)monomers and five additives were detected in the methanol eluates of all three materials tested. The XTT-based cell viability assays resulted in a EC50 of 3006 ± 408 µmol/l for THFMA, 2569.5 ± 308 µmol/l for BDDMA and 596.7 ± 88 µmol/l for TPGDA. SIGNIFICANCE: With the solvent methanol, released components from the investigated splint materials exceeded cytotoxic concentrations in HGFs calculated for a worst-case scenario in splint size. In the water eluates only the methacrylate THFMA could be determined from SHERAprint-ortho plus in concentrations below cytotoxic levels in HGFs.