Accuracy of 3-unit fixed dental prostheses fabricated on 3D-printed casts.

STATEMENT OF PROBLEM: Three-dimensional (3D)-printed casts are used successfully as diagnostic casts in orthodontics. However, whether 3D-printed casts are sufficiently accurate to be used as definitive casts for fixed dental prostheses (FDPs) is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the fit of 3-unit FDPs fabricated on 3D-printed casts made by digital light processing and to investigate the clinical applicability of 3D printing. MATERIAL AND METHODS: A master model was fabricated from epoxy resin. Stone casts were made from dual viscosity impressions (conventional stone cast [CS] group, n=10). The 3D-printed casts were fabricated using a 3D printer after obtaining digital virtual casts by digital scans (3D-printed cast [3DP] group, n=10). All FDPs were fabricated with a 5-axis milling machine. The master model and intaglio surface of the milled FDPs was superimposed using 3D analysis software to measure the accuracy. Two-way ANOVA was performed to identify a significant difference between the groups (3DP and CS) and sides (pontic side, nonpontic side) and their interactive effects (α=.05). The Tukey honestly significant difference test was used for post hoc analysis. RESULTS: Two-way ANOVA showed significant differences between the 2 groups (3DP and CS) in the marginal and internal root mean square (RMS) values (P<.001). However, no significant difference was found in the marginal RMS values (P=.762) between the pontic and nonpontic sides. The 3DP showed significantly higher RMS values than the CS (P<.001). CONCLUSIONS: The fit of FDPs produced from 3D-printed casts was inferior to that of conventional stone casts; however, all FDPs showed clinically acceptable accuracy. These results suggest that 3D-printed casts have clinical applicability but that further improvement of the 3D printer is necessary for their application in prosthodontics.

Effects of core and veneer thicknesses on the color of CAD-CAM lithium disilicate ceramics.

STATEMENT OF PROBLEM: The color of dental ceramics is important for achieving successful esthetic restorations. However, insufficient studies are available of the color of recently introduced computer-aided design-computer-aided manufacturing (CAD-CAM) lithium disilicate ceramics as functions of the core and veneer thicknesses. PURPOSE: The purpose of this in vitro study was to evaluate the effects of the thickness of different core and veneer thicknesses on the color of CAD-CAM lithium disilicate ceramics. MATERIAL AND METHODS: A total of 42 specimens from 2 groups of 7 ceramic cores at 3 thicknesses (0.8, 1.0, and 1.2 mm) were fabricated. The veneer was fabricated at 3 thicknesses (0.3, 0.5, and 0.7 mm). The group name was based on the name of the ceramic core (IPS e.max CAD; lithium disilicate [LD], IPS Empress CAD; leucite-reinforced glass-ceramic [LR]), and the associated number was determined by the combined thicknesses of the core and the veneer: 1=0.8+0.7; 2=1.0+0.5; and 3=1.2+0.3. The color coordinates and the color differences were calculated using a spectrophotometer. The color difference was analyzed using the CIEDE2000 chrominance and the acceptability threshold. Two-way ANOVA was used to identify the color difference based on the core/veneer thicknesses, and the Tukey honest significant differences and Games-Howell tests were conducted to verify the ΔE00 differences of the group (α=.05). In addition, regression analysis was carried out to estimate the causal relationship between the independent variables and the chrominance. RESULTS: At a certain thickness, the color differences of LD1, LR1, and LR2 were not clinically acceptable based on the thicknesses of the core and the veneer. Results of 2-way ANOVA demonstrated that the different thicknesses of core/veneer combination significantly affected the color difference (P<.05). A significant interaction was present between the thickness and the material (P<.05). The results of multiple regression analyses showed that the average color difference of LR increased by 0.019 as the thickness of the core decreased by 0.2 mm. CONCLUSIONS: The color is influenced by the thicknesses of the core and the veneer. With a certain thickness, the color differences increased as the thickness of the core decreased, and lithium disilicate ceramics were less vulnerable to standard deviation of color difference compared with the leucite-reinforced ceramics.

Evaluation of the fit of metal ceramic restorations fabricated with a pre-sintered soft alloy.

STATEMENT OF PROBLEM: Fit is an important factor influencing the success or failure of restorations. Recently, there has been increasing use of a newly developed pre-sintered soft alloy for use in computer-aided design and computer-aided manufacturing (CAD-CAM) of cobalt-chromium alloys for the fabrication of metal ceramic restorations. However, almost no studies are available on the fit of restorations fabricated in this way. PURPOSE: The purpose of this in vitro study was to evaluate the fit of metal coping fabricated from a newly developed CAD-CAM soft alloy in order to investigate its clinical applicability. MATERIAL AND METHODS: Metal coping was categorized as casting alloy (CA), fully sintered hard alloy (FHA), or pre-sintered soft alloy (PSA) depending on the material, and 10 specimens of each category were fabricated. Seven measurement locations were selected in both the mesiodistal and labiolingual directions. For measurement of the marginal and internal discrepancies, silicone molds produced using a silicone replica technique were divided into mesiodistal and labiolingual cross-sections, and the width was measured. The Kruskal-Wallis and Mann-Whitney U test were performed (corrected α error level=.05/3). RESULTS: The mean values of the total discrepancy were smallest in the CA group (52.53 ±33.40 µm) and largest in the FHA group (87.84 ±39.43 µm). The CA group and the PSA group were not significantly different from each other (P>.05) but were statistically significantly different from the FHA group (P<.001). In particular, the absolute marginal discrepancy did not differ significantly between the CA (33.68 ±8.44 µm) and PSA groups (37.01 ±8.04 µm) (P>.05). CONCLUSIONS: The fit of the PSA restorations determined by this study was similar to that of conventional cast restorations. Both FHA and PSA restorations demonstrated clinically acceptable values (<120 µm).

Effects of Different Thickness Combinations of Core and Veneer Ceramics on Optical Properties of CAD-CAM Glass-Ceramics.

The goal of this study was to evaluate the effects of different core and veneer thicknesses on the translucency (T%), average light transmittance (T), translucency parameter (TP), contrast ratio (CR), and spectral reflectance (R) of glass-ceramics using a computer-aided design/computer-aided manufacturing (CAD-CAM) process. In all, 42 specimens (11mm × 11mm) were prepared and divided into six groups (n = 7 for each group). Core materials (IPS e.max CAD; IPS Empress CAD, LT A2 shade) of different thicknesses (0.8, 1.0, and 1.2mm) were fabricated. Each veneer material (thicknesses of 0.7, 0.5, and 0.3mm) was combined with its compatible core ceramic. Each core material was overlapped with its corresponding veneer material to obtain a 1.5-mm thickness by using three different combinations: (0.8+0.7), (1.0+0.5), and (1.2+0.3) mm. A spectrophotometer and color data software were used to measure the T%, T, TP, CR, and R values of each ceramic. The results were statistically analyzed using two-way analysis of variables (ANOVA) and regression analysis (p<0.05). Two-way ANOVA revealed that T%, T, TP, and CR were significantly influenced by the different thicknesses of the core-veneer combinations (p<0.001). At a certain thickness, as the veneer thickness increased and core thickness decreased, T and T% all increased. Regression analysis of the ceramic materials indicated a reduction in T and T% for certain core-veneer combinations. Analysis also revealed that T% and T were all affected by different core-veneer combinations. The T% value was 74.31 for the EM group and 72.81 for the EP group when the thickness of the core was 1.2 mm and the veneer was 0.3 mm. The R value of EM2 was lower than EM1 and EM3. In conclusion, the optical properties were influenced by different core-veneer combinations.

Evaluation of the marginal and internal fit of a single crown fabricated based on a three-dimensional printed model.

PURPOSE: To evaluate the fit of a crown produced based on a 3D printed model and to investigate its clinical applicability. MATERIALS AND METHODS: A master die was fabricated with epoxy. Stone dies were fabricated from conventional impressions (Conventional stone die group: CS, n=10). Digital virtual dies were fabricated by making digital impressions (Digital Virtual die group: VD, n=10). 3D data obtained from the digital impression was used to fabricate 3D printed models (DLP die group: DD, n=10, PolyJet die group: PD, n=10). A total of 40 crowns were fabricated with a milling machine, based on CS, VD, DD and PD. The inner surface of all crowns was superimposed with the master die files by the "Best-fit alignment" method using the analysis software. One-way and 2-way ANOVA were performed to identify significant differences among the groups and areas and their interactive effects (α=.05). Tukey's HSD was used for post-hoc analysis. RESULTS: One-way ANOVA results revealed a significantly higher RMS value in the 3D printed models (DD and PD) than in the CS and DV. The RMS values of PD were the largest among the four groups. Statistically significant differences among groups (P<.001) and between areas (P<.001) were further revealed by 2-way ANOVA. CONCLUSION: Although the fit of crowns fabricated based on the 3D printed models (DD and PD) was inferior to that of crowns prepared with CS and DV, the values of all four groups were within the clinically acceptable range (<120 µm).

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.

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.

Adult intussusception caused by an appendiceal mucocele and reduced by colonoscopy.

Appendiceal intussusception is a very rare disease that is found in only 0.01% of patients who have undergone an appendectomy. Clinical symptoms vary but include acute appendicitis symptoms such as right lower quadrant abdominal pain or repetitive right lower quadrant crampy pain. Some patients are asymptomatic. Operative treatment is necessary to reduce an appendiceal intussusception in adults, but there is a debate about how to perform the reduction. Successful colonoscopic reductions have been recently reported for some cases. We report a case of appendiceal intussusception that was diagnosed, reduced by colonoscopy, and histologically confirmed as a mucinous cystadenoma after the operation.