Does the choice of the measuring technique affect the comparison of fit between zirconia and cobalt-chromium prostheses?

AIMS: The objectives of the study were to compare the adaptation of presintered zirconia and cobalt- chromium prostheses using microcomputed tomography (µCT), scanning electron microscopy (SEM), and stereomicroscope (SM). MATERIALS AND METHODS: Twenty-four fixed dental prostheses (FDPs) were fabricated on metal abutments, duplicated from maxillary first premolar and first molar prepared on a typodont model. Teeth were reduced to obtain chamfer of 1.2 mm and reduction occlusaly of 2 mm occlusal. Scanning of the abutments was done with random assignment to two groups receiving the FDPs made from soft-milled Co-Cr (n = 12) and zirconia (n = 12). Marginal and internal gaps were assessed using three evaluation techniques (X-ray microcomputer tomography, SEM, and stereomicroscopy). STATISTICAL ANALYSIS USED: Comparison of the results was made using Levene and analysis of variance tests (α =0.05). RESULTS: Irrespective of the material tested, statistical differences were found between the measuring techniques (P = 0.001 overall); the obtained mean gaps were for CT scan (92.60 ± 13.31), for SEM (101.92 ± 23.03), and for SM (113.44 ± 14.68): the multiple comparisons between techniques found a significant difference between CT and SM (P < 0.001), and SEM and SM (P = 0.025). When materials were compared within each measuring technique, Co-Cr showed lower values compared to zirconia in SEM (P < 0.001) and Stereo (P = 0.049); similar results were found in CT. CONCLUSIONS: Results values differed with the chosen measuring technique. Co-Cr prostheses had a better fit than zirconia prostheses in SEM and Stereo. µCT showed comparable results to SEM, smaller than SM results.

Does the Build Orientation Parameter Affect the Fit of Fixed Partial Dentures Fabricated by Additive Manufacturing?

PURPOSE: This in vitro study evaluated the adaptation of cobalt-chromium (Co-Cr) fixed dental prostheses (FDPs) fabricated by selective laser melting (SLM) with different build angles. MATERIALS AND METHODS: Maxillary right first premolars and first molars from a typodont were prepared with 1-mm chamfer, 2-mm occlusal reduction, and total taper of 8 degrees to receive three-unit FDPs. After framework design, data were sent to a laser machine, and 30 specimens were fabricated from Co-Cr metal powder by SLM. Specimens were assigned to three groups (n = 10 per group) with different build angles of 0 (A0), 30 (A30), and 45 (A45) degrees. Marginal and internal fit were evaluated. Results were compared among build orientation groups and abutments. Data were analyzed using the Levene test, t test, and analysis of variance (α = .05). RESULTS: A statistical difference was found between different angle groups (P = .015). At the abutment level, a significant difference was found in the gap values between build orientation groups for the molars (P = .048). Group A0 reported the smallest mean discrepancy values, and group A45 the highest. Statistical differences were found between group A45 and groups A0 (P < .001) and A30 (P < .024). CONCLUSIONS: The fit of printed metal FDPs was affected by the build orientation but remained clinically acceptable.

The Effect of Firing Cycles on the Fit of Cobalt-Chromium Multiunit Prostheses Fabricated by Additive Manufacturing.

PURPOSE: The effect of annealing and firing cycle on the adaptation of cobalt-chromium (CoCr) restorations fabricated by additive manufacturing has been poorly documented. This study compared the marginal and internal fit of CoCr three-unit fixed dental prostheses before and after firing cycles. MATERIAL AND METHODS: The first right maxillary premolar (MP) and molar (MM) on a typodont model, were prepared with a circumferential 1.2 mm chamfer, 2 mm occlusal reduction, and total taper of 8 degrees, to receive 3-unit fixed dental prostheses (FDP). After the framework design, 20 framework specimens were fabricated using CoCr metal powder by selective laser melting. The replica technique was used for marginal and internal fit measurements in mesiodistal and buccolingual planes. The specimens were submitted to an annealing process, and to ceramic firing protocol. Measurements were repeated after each firing cycle. The data were compared by using Levene test, t-test, and analysis of variance (ANOVA) (α = 0.05). RESULTS: A significant difference was found in the total intaglio surface discrepancy between the 3 treatments. The annealing treatment induced a statistical difference in the discrepancy value compared to the as printed state (p = 0.028). A significant difference was detected between the initial manufacturing phase and the ceramic layering firing cycle (p = 0.003). CONCLUSIONS: Firing cycles induced an alteration of the frameworks adaptation.

Evaluation of ceramic adherence to cobalt-chromium alloys fabricated by different manufacturing techniques.

STATEMENT OF PROBLEM: Selective laser melting has been increasingly used in the fabrication of metal-ceramic prostheses. The longevity of the prostheses depends on the strength of the metal-ceramic bond, which may differ with the framework manufacturing technique. PURPOSE: The purpose of this in vitro study was to compare the bond strength of ceramic to cobalt-chromium (Co-Cr) alloys fabricated by different manufacturing methods. MATERIAL AND METHODS: Sixty Ø15×2-mm disk-shaped specimens were prepared and assigned to 3 groups (n=20) with different manufacturing methods: milled Co-Cr (M), selective laser melted Co-Cr (SLM), and cast Co-Cr (C). The disks were ceramic layered with a 2-mm thickness. Half of the specimens from each group were thermocycled. The shear bond strength (SBS) test was applied to all specimens. The microstructure changes after ceramic layering were evaluated by X-ray diffraction (XRD). The specimens' surface morphology was analyzed by using scanning electron microscopy (SEM). RESULTS: Thermocycling had a significant effect on SBS values in the SLM group (P=.017). Considering the registered Fmax (force inducing bonding failure), a significant difference was found between SLM and both M and C groups (P<.001). No significant difference was found between milled and cast Co-Cr (P=.885). The failure types were mostly mixed failures. Ceramic layering induced a crystallization increase in groups C and SLM. CONCLUSIONS: The adhesion strength of ceramic to Co-Cr differed with alloy composition and manufacturing technique. The aging process influenced the results in the SLM group.

Does the Build Orientation Parameter Affect the Fit of Fixed Partial Dentures Fabricated by Additive Manufacturing?

PURPOSE: To evaluate the adaptation of cobalt-chromium (Co-Cr) fixed dental prostheses (FDPs) fabricated using selective laser melting (SLM) with different build angles. MATERIALS AND METHODS: The maxillary right first premolar and molar from a typodont were prepared with a 1-mm chamfer, a 2-mm occlusal reduction, and a total taper of 8 degrees to receive three-unit FDPs. After framework design, the data were sent to a laser machine, and 30 specimens were fabricated from Co-Cr metal powder by SLM. Specimens were assigned to three groups (n = 10 each) with different build angles of 0 (A0), 30 (A30), and 45 (A45) degrees. The marginal and internal fit were evaluated, and the results were compared among the build orientation groups and abutments. Data were analyzed by using Levene test, t test, and analysis of variance (ANOVA; α = .05). RESULTS: A statistical difference was found between the different angle groups (P = .015). At the abutment level, a significant difference was found in the gap values between the build orientation groups for the molars (P = .048). Group A0 reported the smallest mean discrepancy values and group A45 the highest; statistical differences were found between groups A45 and A0 (P < .001) and A45 and A30 (P < .024). CONCLUSION: The fit of printed metal FDPs was affected by the build orientation but remained clinically acceptable.

Effect of lamination layer thickness and abutment preparation on the fit of Co-Cr multi-unit prostheses fabricated by additive manufacturing: An in vitro study.

STATEMENT OF PROBLEM: Selective laser melting has been increasingly used in the fabrication of metal-ceramic prostheses. The lamination layer thickness may influence the fit of the restoration. However, data regarding its impact remain scarce. PURPOSE: The purpose of this in vitro study was to evaluate the marginal and internal fit of cobalt-chromium (Co-Cr) 3-unit frameworks fabricated by additive manufacturing with different melting layer thicknesses on different abutments. MATERIAL AND METHODS: The first right maxillary premolar and molar from a typodont were prepared with a circumferential 1.2-mm chamfer, 2-mm occlusal reduction, and total taper of 8 degrees to receive 3-unit fixed partial dentures. After framework design, the data were sent to a laser machine, and 30 specimens were fabricated from Co-Cr metal powder (Mediloy S-Co) by selective laser melting. Specimens were assigned to 3 groups (n=10) with different lamination layer thicknesses of 25 (L25), 50 (L50), and 100 (L100) µm. Marginal fit and internal fit were evaluated. Results were compared among layer thickness groups and abutments. Data were compared by using the Levene test, t test, and ANOVA (α=.05). RESULTS: A statistical difference was found between different layer thickness groups (P=.016), but not between abutments (P=.429). On the abutment level, significant difference was found in the gap values for the molars (P=.049) between layer thickness groups, but not for the premolars (P=.126). Group L25 reported the smallest mean discrepancy values, and group L100 reported the highest, with statistical difference found between group L100 and groups L25 (P<.001) and L50 (P<.025), but not between groups L25 and L50 (P=.094). CONCLUSIONS: The lamination layer thickness affected the adaptation of the metal frameworks. Framework fit did not significantly differ between abutments.

X-ray microtomographic evaluation of the absolute marginal fit of fixed prostheses made from soft Co-Cr and zirconia.

STATEMENT OF PROBLEM: The absolute marginal fit of CAD-CAM presintered fixed partial dentures has been poorly documented. PURPOSE: The purpose of this in vitro study was to evaluate the marginal fit of presintered cobalt-chromium (Co-Cr) and zirconia 3-unit fixed partial dentures by using X-ray microcomputed tomography (µCT). MATERIAL AND METHODS: A metal model was prepared from a typodont to receive fixed partial dentures (N=12). The maxillary first premolar and first molar were prepared with a circumferential 1.2-mm chamfer and 2-mm occlusal reduction. The dies were scanned and assigned to 1 of 2 groups to receive the prostheses made of presintered Co-Cr or presintered zirconia (n=6). Each framework was seated on its model without load application. The abutments were scanned by using µCT. A circle with 10 diameters, with a step of 18 degrees, was projected at the center of the obtained image. Absolute marginal discrepancy and marginal gap mean values were measured, and overextended and underextended margins determined. The data were analyzed by using the Levene t test and ANOVA (α=.05). RESULTS: No statistically significant difference was found in the marginal fit between the materials tested (P=.939). The mean values were 66 ±14 µm for Co-Cr and 61 ±12 µm for zirconia. The absolute marginal discrepancy mean value for the premolar was 69 ±12 µm and 41 ±9 µm for the molar (P<.001). Overextension was predominant for both materials tested, with a higher percentage reported for the zirconia group. CONCLUSIONS: Presintered alloys presented clinically acceptable adaptation with a predominance of marginal overextensions.

Effect of ceramic layering on the fit of cobalt-chromium alloy 3-unit fixed dental prostheses fabricated by additive, soft milling, and casting technologies.

STATEMENT OF PROBLEM: The change in fit after ceramic layering of additively manufactured cobalt-chromium alloy frameworks has not been evaluated extensively. PURPOSE: The purpose of this in vitro study was to compare the fit of cobalt-chromium alloy fixed dental prostheses fabricated by different techniques before and after ceramic layering. MATERIAL AND METHODS: A cobalt-chromium alloy master model was prepared to receive a 3-unit fixed dental prosthesis. Sixty cobalt-chromium alloy frameworks (N=60) were manufactured by using 3 manufacturing techniques (n=20): selective laser melting (Mediloy S-Co), soft milling (Ceramill Sintron), and conventional casting as the control group (Girobond NB). The replica technique was used to measure the marginal and internal discrepancies. The frameworks were then layered with ceramic, and the same fit measuring procedure was repeated. The results were compared before and after ceramic layering within each group. The data were analyzed using the Levene, ANOVA, and paired-samples t tests (α=.05). RESULTS: A significant difference was found within groups before and after ceramic layering for selective laser melting (P=.006) and soft milling (P=.009) but not for conventional casting (P>.05). No statistical difference was reported in the marginal region for conventional casting group (P=.155) in contrast with the soft milling and selective laser melting groups (P=.003). Soft milling showed increased gap values in the marginal (P=.006) and occlusal regions (P=.004). CONCLUSIONS: Ceramic layering increased the discrepancy of the laser-sintered and milled frameworks, increasing the marginal discrepancy.

Comparison of fit accuracy of three-unit fixed ceramic-CoCr dental prostheses fabricated by three different techniques.

PURPOSE: To compare the precision of adaptation of cobalt-chromium (Co-Cr) three-unit fixed dental prostheses (FDPs) fabricated using different techniques. MATERIALS AND METHODS: A master model was prepared to receive a three-unit FDP. This model was duplicated 60 times from a silicone mold. The dies (N = 60) were scanned and divided into three groups (n = 20 each) to receive the FDPs made of pre-sintered Co-Cr (CS), laser-sintered Co-Cr (LS), or cast Co-Cr (Gi). Frameworks were layered with ceramic, and each framework was seated on its specific model. The replica technique was used to measure the marginal and internal discrepancies in the mesiodistal and buccolingual planes. Prepared silicone samples were examined with scanning electron microscopy. Obtained data were analyzed using Levene test, t test, and analysis of variance (α = .05). RESULTS: When overall mean discrepancy values were compared, in mesiodistal planes, LS showed better adaptation than Gi (P = .025). Similar adaptation was found for CS and Gi, and for CS and LS (P = .169 and P = 1.000, respectively). In buccolingual planes, the difference in fit was not significant among the three tested groups (P > .05). In a pairwise comparison between materials, a net increase in values between points 1 and 5 was noted (P = .57). Difference in discrepancy values within points was significant. This was confirmed at abutment level on some measurement points. Within each material, at abutment level, differences were significant at several measurement locations in both the mesiodistal and buccolingual planes. CONCLUSION: Within the limitations of this study, three-unit Co-Cr FDPs showed similar marginal and internal discrepancy values. Presintered and laser-sintered Co-Cr alloys can be considered for three-unit FDP fabrication.

Fit Alteration of Presintered Co-Cr and Zirconia Multiple-Unit Prostheses After Ceramic Layering.

PURPOSE: The fit alteration after ceramic layering of soft Cobalt-Chromium (Co-Cr) and zirconia is poorly documented. This study compared the marginal and internal fit of presintered Co-Cr and zirconia three-unit fixed dental prostheses before and after ceramic veneering. MATERIALS AND METHODS: Co-Cr master model was prepared and duplicated 60 times to receive three-unit fixed dental prostheses (FDPs). Sixty dies were prepared, scanned and assigned to 3 groups (n = 20/group), to receive the FDPs made of presintered Co-Cr (CS), presintered zirconia (CZ) and cast Ni-Cr (Wi). Each framework was seated on its specific cast. A replica technique was used for marginal and internal discrepancy measurements in mesiodistal and buccolingual planes. Frameworks were ceramic veneered. Results were compared before and after ceramic layering within each group. Data were analyzed using the Levene, t test, and ANOVA (α = 0.05). RESULTS: Significant difference was found when gaps were compared within groups for CS and CZ but not for Wi. At the abutments level, significant difference was found for both premolars and molars in the buccolingual planes (p < 0.001). A multiple comparison between materials tested showed significant differences between presintered and cast Ni-Cr. No significant difference was detected between CS and CZ (p = 1.000). CONCLUSIONS: Although ceramic layering increased the discrepancy for presintered Co-Cr and zirconia, the marginal adaptation remained clinically acceptable.

Evaluation of Marginal and Internal Fit of Presintered Co-Cr and Zirconia Three-Unit Fixed Dental Prosthesis Compared to Cast Co-Cr.

PURPOSE: The precision of soft metal processing technologies is poorly documented. This study compared marginal and internal fit of presintered cobalt-chromium (Co-Cr) and zirconia three-unit fixed dental prostheses (FDPs) to cast Co-Cr. MATERIALS AND METHODS: Three-unit FDPs were prepared on metal dies (N = 60) from typodont preparations of the maxillary right first premolar and molar. A standardized preparation of a metal-ceramic restoration was done on abutment teeth. The dies (N = 60) were scanned and divided into three groups (n = 20/group) to receive the FDP made of presintered Co-Cr (Ceramill Si), presintered zirconia (Ceramill Zi), and cast Co-Cr (Girobond NB). Each framework was seated on its specific cast. A replica technique was used for marginal and internal discrepancies measurements in mesiodistal and buccolingual planes. Data were analyzed using the Levene test, t-test, and analysis of variance (α = 0.05). RESULTS: When the overall mean discrepancy values were compared in the mesiodistal plane, a significant difference was found between Ceramill Sintron and Ceramill Zi groups (p = 0.026). No significant difference was detected between Girobond NB and Ceramill Sintron groups and between Girobond NB and Ceramill Zi groups (p = 0.537 and p = 0.569, respectively). In the buccolingual plane, there was no significant difference in the overall mean discrepancy between the three groups: CS/CZ (p = 1.000), GI/CS (p = 0.51), and GI/CZ (p = 0.87). Significant differences at several measurement points were found at the inter or intramaterial level. The increase in discrepancy values between marginal and occlusal measurements was evident for the three groups. CONCLUSIONS: Presintered three-unit FDPs fabricated from zirconia and Co-Cr exhibited internal and marginal discrepancy values similar to cast Co-Cr. A significant difference was reported between CS and CZ in mesiodistal planes. The axial and marginal differences in values for the three tested groups were below or around the 120 µm clinically acceptable threshold except for the occlusal area. When comparing first premolar to first molar, the internal and marginal discrepancies were similar with no apparent distortion of the framework after the sintering process.

Comparison of Adhesion of a Novel Pre-sintered Cobalt-Chromium to Pre-sintered Zirconia and Cast Nickel-Chromium.

AIM: This study compared the bond strength of pre-sintered Ceramill Sintron to pre-sintered zirconia and cast nickel-chromium (NiCr). MATERIALS AND METHODS: Specimens (n = 60) (diameter: 15 mm; thickness: 2 mm) were prepared (n = 20/group) (Ceramill Sintron, Ceramill Zi, and Wirobond 99). Disks were layered with vita VM ceramic (4 mm). Specimens were randomly divided into two subgroups. Only one subgroup was thermocycled. Specimens were tested under shear strength. Energy-dispersive X-ray (EDX) mapping was done on one disk of each material before and after ceramic layering. RESULTS: Failure types were mostly mixed failures. Significant difference was found between the three materials for Y and Z failure types (p-values: 0.032 and 0.010 respectively). Thermocycling had no major effect on the results reported. Considering Fmax (force-inducing bonding failure) registered, significant difference was found between the control group and milled alloys groups. No significant difference was found between Ceramill Sintron and Zi. The EDX mapping showed a net increase in the control group oxide layer, whereas only slight increase and decrease were reported for Zi and Sintron respectively. CONCLUSION: When compared with cast NiCr, novel Ceramill Sintron has higher bond strength, comparable to Ceramill Zi. Thermocycling had no major effects on the results. CLINICAL SIGNIFICANCE: Ceramic-alloy bonding is a primary factor in the prosthesis' longevity.

Marginal and internal fit of pre-sintered Co-Cr and zirconia 3-unit fixed dental prostheses as measured using microcomputed tomography.

STATEMENT OF PROBLEM: Limited information is available on the precision of new metal processing technologies. PURPOSE: The purpose of this in vitro study was to evaluate the marginal and internal fit of pre-sintered cobalt-chromium (Co-Cr) and zirconia 3-unit fixed dental prostheses using x-ray microcomputed tomography. MATERIAL AND METHODS: Three-unit fixed dental prostheses were prepared on metal dies (N=12) using a typodont model from the maxillary first premolar to the first molar. A standardized preparation with a 1.2-mm chamfer (360 degrees) and a 2-mm occlusal reduction was prepared on abutment teeth. The dies were scanned and divided into 2 groups to receive the fixed dental prostheses (n=6) made of pre-sintered Co-Cr and pre-sintered zirconia. Each framework was seated on its cast, and marginal and internal discrepancies were measured at 9 points, starting from the most distal point from the pontic for the maxillary first premolar and the first molar (points 1-4, mesial; point 5, occlusal; points 6-9, distal) of each abutment tooth using microcomputed tomography. The data were analyzed using the Levene test, t test, and ANOVA (α=.05). RESULTS: When overall mean discrepancy values were compared, no significant difference was observed between pre-sintered Co-Cr and pre-sintered zirconia (P=.085). Discrepancy values for points 1, 2, and 3 were significantly different for pre-sintered Co-Cr and pre-sintered zirconia, with the lowest mean values for point 1 and the highest for point 5. On the abutment tooth basis, for the maxillary first premolar and the first molar, a significant difference was found only in points 6 (P<.001) and 8 (P<.003) for both materials. When the discrepancies for the maxillary first premolar were considered for pre-sintered Co-Cr and pre-sintered zirconia, the mean values were significantly different only at points 1 (P<.001), 2 (P=.007), and 3 (P=.003) and were smaller for pre-sintered zirconia. For the tooth the first molar, a significant difference was observed at point 2 (P=.002) and point 3 (P=.008) for both materials, where the mean values were higher for pre-sintered Co-Cr than for pre-sintered zirconia. The pairwise comparison between points showed a significant difference between measurement points within each material (P<.05). The increase in values between points 1 and 5 was evident for both pre-sintered Co-Cr and pre-sintered zirconia materials. CONCLUSIONS: Three-unit fixed dental prostheses made of pre-sintered Co-Cr or zirconia showed similar marginal and internal discrepancy values, with the highest discrepancy values at the occlusal region in both the first premolar and first molar.

Biomaterial aspects: A key factor in the longevity of implant overdenture attachment systems.

BACKGROUND: New attachment systems are released for mandibular two-implant overdentures often without evidence-based support. Biomaterial aspects are now the parameters considered when choosing the appropriate attachment. Studies regarding their properties remain scarce. PURPOSE: The purpose of this review was to help the clinician in selrcting the most adapted stud attachments according evidence-based dentistry. MATERIALS AND METHODS: An electronic search was conducted using specific databases (PubMed, Medline, and Elsevier libraries). Peer-reviewed articles published in English up to July 2014 were identified. Emphasis was given on the biomaterial aspects and technical complications. No hand search was added. RESULTS: The electronic search generated 115 full-text papers, of which 84 papers were included in the review. The majority were clinical and in vitro studies. Some review articles were also considered. Papers reported survival and failures of overdenture connection systems. Emphasis was laid on attachment deformation. CONCLUSION: Implant overdentures long-term follow-up studies may provide useful guidelines for the clinician in selecting the type of attachment system and overdenture design. Locator attachments are more and more used, with lesser complications reported.

Esthetic Prosthetic Restorations: Reliability and Effects on Antagonist Dentition.

Recent advances in ceramics have greatly improved the functional and esthetic properties of restorative materials. New materials offer an esthetic and functional oral rehabilitation, however their impact on opposing teeth is not welldocumented. Peer-reviewed articles published till December 2014 were identified through Pubmed (Medline and Elsevier). Scientifically, there are several methods of measuring the wear process of natural dentition which enhances the comparison of the complicated results. This paper presents an overview of the newly used prosthetic materials and their implication on antagonist teeth or prostheses, especially emphasizing the behavior of zirconia restorations.

The zirconia ceramic: strengths and weaknesses.

Metal ceramic restorations were considered the gold standard as reliable materials. Increasing demand for esthetics supported the commercialization of new metal free restorations. A growing demand is rising for zirconia prostheses. Peer-reviewed articles published till July 2013 were identified through a Medline (Pubmed and Elsevier). Emphasizing was made on zirconia properties and applications. Zirconia materials are able to withstand posterior physiologic loads. Although zirconia cores are considered as reliable materials, these restorations are not problem free.

Stud attachments for the mandibular implant-retained overdentures: Prosthetic complications. A literature review.

A plethora of attachment systems for mandibular two-implant overdentures is currently available often without evidence-based support. Technical aspects are now parameters considered when choosing the appropriate attachment. Despite the increasing use of the Locator attachments, studies regarding their properties remain scarce. Peer reviewed articles published in English up to 2011, were identified through a MEDLINE search (Pubmed and Elsevier) and a hand search of relevant textbooks and annual publications. Emphasis was made on the technical complications as well as the loss of retention related to the attachments in implant-retained overdentures, primarily the Locator attachment. The evaluation of the long-term outcome of implant overdentures and complications associated with different attachment systems may provide useful guidelines for the clinician in selecting the type of attachment system and overdenture design.

The elastomers for complete denture impression: A review of the literature.

This article reviews the current trends in materials used for complete denture impression. Peer-reviewed articles, published in English and in French between 1954 and 2007, were identified through a MEDLINE search (Pubmed and Elsevier) and a hand search of relevant textbooks and annual publications. Emphasis was made on the characteristics of the elastomers, their manipulation, the different techniques used, and the quality of the impression obtained. The combination of excellent physical properties, handling characteristics, and unlimited dimensional stability assures the popularity of these impression materials.