In-vitro evaluation of marginal and internal fit of 3-unit monolithic zirconia restorations fabricated using digital scanning technologies

PURPOSEThis study aimed to compare the marginal and internal fit of 3-unit monolithic zirconia restorations that were designed by using the data obtained with the aid of intraoral and laboratory scanners.MATERIALS AND METHODSFor the fabrication of 3-unit monolithic zirconia restorations using impressions taken from the maxillary master cast, plaster cast was created and scanned in laboratory scanners (InEos X5 and D900L). The main cast was also scanned with different intraoral scanners (Omnicam [OMNI], Primescan [PS], Trios 3 [T3], Trios 4 [T4]) (n = 12 per group). Zirconia fixed partial dentures were virtually designed, produced from presintered block, and subsequently sintered. Marginal and internal discrepancy values (in µm) were measured by using silicone replica method under stereomicroscope. Data were statistically analyzed by using 1-way ANOVA and Kruskal Wallis tests (P<.05).RESULTSIn terms of marginal adaptation, the measurements on the canine tooth indicated better performance with intraoral scanners than those in laboratory scanners, but there was no difference among intraoral scanners (P<.05). In the premolar tooth, PS had the lowest marginal (86.9 ± 19.2 µm) and axial (92.4 ± 14.8 µm), and T4 had the lowest axio-occlusal (89.4 ± 15.6 µm) and occlusal (89.1 ± 13.9 µm) discrepancy value. In both canine and premolar teeth, the D900L was found to be the most marginally and internally inconsistent scanner.CONCLUSIONWithin the limits of the study, marginal and internal discrepancy values were generally lower in intraoral scanners than in laboratory scanners. Marginal discrepancy values of scanners were clinically acceptable (< 120 µm), except D900L.     

Marginal adaptation of zirconia complete-coverage fixed dental restorations made from digital scans or conventional impressions: A systematic review and meta-analysis

Statement of problemIntraoral scanners have been increasingly used in recent years. However, the accuracy of digital scans as it affects marginal adaptation is unclear.PurposeThe purpose of this systematic review and meta-analysis was to compare the marginal adaptation of single-unit zirconia crowns fabricated with digital scans or with conventional impressions.Material and methodsThe electronic databases PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (ISI), Scopus, and EMBASE were searched and complemented by a manual search. Risks of bias were assessed by using a modified methodological index for nonrandomized studies (MINORS). Mean ±standard deviation (SD) values of marginal accuracy of studies were extracted for both methods. Mean marginal difference and 95% confidence interval (CI) were calculated to evaluate the marginal accuracy of each method. Pooled data were statistically analyzed by using a random-effect model.ResultsSeventeen studies were used to perform the meta-analysis. Subgroup analysis was performed based on intraoral scanners. Standardized mean marginal difference and 95% CI of each subgroup were as follows: Lava: -0.85 μm (95% CI: -1.67, -0.03) (P=.043); CEREC: -1.32 μm (95% CI: -2.06, -0.59) (P<.001); iTero: -0.44 μm (95% CI: -1.35, 0.47) (P=.338); TRIOS: -1.26 μm (95% CI: -2.02, -0.51) (P=.001); unknown scanner: -0.21 μm (95% CI: -1.14, 0.72); all studies: -0.89 μm (95% CI: -1.24, -0.54) (P<.001).ConclusionsDigital scanning of prepared teeth for single-unit zirconia restorations resulted in better marginal accuracy than conventional techniques using elastomeric impression materials.     

Fit of 4-unit FDPs from CoCr and zirconia after conventional and digital impressions

Objectives

To evaluate the marginal and internal fit of CAD/CAM-generated frameworks for 4-unit, fixed dental prostheses (FDPs) from zirconia (Z) and cobalt-chromium alloy (C) made with conventional (CI) and digital impressions (DI).

Materials and methods

A titanium model was digitized with an intraoral scanner (DI, LAVA? C.O.S.; 3M ESPE; Seefeld, Germany; n = 12). Additionally, 12 conventional impressions were taken, and referring plaster casts were digitized by a laboratory-scanner (CI, LAVA? Scan ST; 3M ESPE; n = 12). Frameworks were fabricated (3M ESPE) from cobalt-chromium (DI-C, n = 12; CI-C, n = 12) and zirconia (DI-Z, n = 12; CI-Z, n = 12) from the same datasets. A replica technique was applied to measure the accuracy. The Mann–Whitney U statistical test was applied to detect statistical differences between each material and methodology groups in terms of fit.

Results

Frameworks from DI-C (median 19.07 μm) showed significantly better marginal fit than CI-C (median 64.64 μm, p < 0.001). Frameworks from DI-Z (median 52.50 μm) showed significantly better marginal fit than CI-Z (median 72.94 μm, p = 0.001). Additionally, frameworks from DI-C showed a significantly better marginal fit than DI-Z (p < 0.001).

Conclusions

CI and DI led to a clinically acceptable marginal fit of 4-unit FDPs from cobalt-chromium and zirconia. DI leads to better marginal fit of the cobalt-chromium frameworks; however, no effect on zirconia was found.

Clinical relevance

The results indicate that DI is suitable for fabricating 4-unit, cobalt-chromium and zirconia frameworks with regard to fit requirements.

     

Marginal and internal fit of four-unit zirconia fixed dental prostheses based on digital and conventional impression techniques

Objectives

The aim of this in vitro study was to evaluate the marginal and internal fit of CAD/CAM-generated four-unit zirconia fixed dental prostheses made with digital and conventional impressions.

Materials and method

A titanium master model was used. For group conventional impression (CI), 12 polyether impressions of the master model with Impregum^TM were made. For group digital impression (DI), 12 digital impressions of the master model using Lava^TM C.O.S. system were made. The replica technique was applied. The Mann–Whitney U statistical test was applied to detect statistical differences between the groups, in terms of marginal and internal fit. Face-by-face comparisons between groups were also carried out.

Results

Groups DI and CI presented mean marginal fit of 63.96 and 65.33 μm, respectively, and showed no statistically significant difference. Groups DI and CI presented significantly different internal fit with mean values of 58.46 and 65.94 μm, respectively. Group DI showed statistically significantly lower values for marginal and internal fit on premolar mesial face, and on molar distal and palatal faces.

Conclusions

Frameworks fabricated from digital and conventional impressions showed clinically acceptable marginal fit. Frameworks fabricated from digital impression demonstrated better internal fit than ones fabricated from conventional impression. Reviewing each retainer face, digital impression showed better marginal and internal fit at the premolar mesial and molar distal faces.

Clinical relevance

The results of this in vitro study show that digital impressions made with the Lava^TM C.O.S. system and its digital workflow are suitable for fabricating four-unit zirconia frameworks, with regard to marginal and internal fit requirements.     

Accuracy of single crowns fabricated from ultrasound digital impressions

Objective

This in vitro study aimed to evaluate marginal and internal fit of single crowns produced from high-frequency ultrasound based digital impressions of teeth prepared with finish lines covered by porcine gingiva, in comparison with those obtained by optical scanners with uncovered finish lines.

口内数字化印模扫描重复性的研究

目的：通过研究口内数字化扫描仪多次扫描的重复性来评价其扫描精度。方法：根据原始研究模型上牙备后基牙的分布不同分为5小组（1.右侧上颌中切牙为牙备后形态,余牙完整;2.右侧上颌第一磨牙为牙备后形态,余牙完整;3.右侧上颌中切牙和尖牙为牙备后形态,上颌侧切牙缺失,余牙完整;4.右侧上颌7颗牙齿为牙备后形态,左半侧完整;5.上颌全部牙齿为牙备后形态）。实验组中,每一小组的研究模型均用TRIOS口内扫描仪10次;对照组中,每一小组的研究模型先分别翻制10副石膏模型,再用3Shape口外扫描仪扫描。实验组和对照组分别得到扫描生成的50个STL三维图像文件,将总共100个STL文件通过Geomagic Studio 12软件进行处理和分析来评价两组扫描的重复性和精度。结果：实验组（口内组）3D标准偏差分别是第1小组：13.33μm,第2小组：7.0μm,第3小组：16.33μm,第4小组：41.56μm,第5小组：88.44μm。对照组的3D标准偏差分别是第1小组：14.89μm,第2小组：8.67μm,第3小组：24.33μm,第4小组：14.22μm,第5小组：12.67μm。实验组和对照组的3D标准偏差在第2,3,4,5小组中有统计学差异（P〈0.05）。结论：口内数字化印模扫描精度随着牙弓扫描范围增大而降低,其在扫描范围小于半个牙弓时表现出的精度符合临床要求;而口外台式扫描仪在扫描任意范围牙弓时均表现出较好的精度。     

Three-dimensional trueness and margin quality of monolithic zirconia restorations fabricated by additive 3D gel deposition

PurposeThe aim of this in vitro study was to evaluate the three-dimensional trueness and margin quality of monolithic zirconia restorations fabricated by additive 3D gel deposition, compared with those by subtractive milling.MethodsTen single crowns and ten 4-unit FPDs of different occlusal geometries and margin thickness were fabricated by additive 3D gel deposition (additive group) and subtractive milling (subtractive group). An intraoral scanner was used to digitalize the restorations. 3D deviation analysis was applied and root mean square (RMS) was used to assess the trueness. Margin quality was characterized using optical stereomicroscopy and 3D laser scanning microscopy.ResultsFor single crowns with shallow fossae and grooves and normal margin, RMS value of additive group and subtractive group showed no significant difference in external surface, while additive group showed higher RMS value in intaglio surface. As for 4-unit FPDs with deep fossae and grooves and thin margin, RMS value of additive group in external surface was significantly lower than that of subtractive group and in intaglio surface there was no significant difference between two groups. With a 0.5 mm chamfer design, single crowns in additive group showed flawless margin with a smooth contour line, whereas minor flaws could be observed in 4-unit FPDs with thin margin. In subtractive group, restorations showed minor flaws or defects of various number and severity.ConclusionsMonolithic zirconia restorations fabricated by additive 3D gel deposition have comparable trueness and better margin quality than those fabricated by subtractive milling. Besides it is more capable of enabling complex geometry.     

Marginal accuracy of four-unit zirconia fixed dental prostheses fabricated using different computer-aided design/computer-aided manufacturing systems

Besides load-bearing capacity, marginal accuracy is a further crucial factor influencing the clinical long-term reliability of fixed dental prostheses (FDPs). The aim of this in vitro study was to evaluate the marginal fit of four-unit zirconia bridge frameworks fabricated using four different computer-aided design (CAD)/computer-aided manufacturing (CAM) systems. Ten frameworks were manufactured using each fabricating system. Three systems (inLab, Everest, Cercon) processed white-stage zirconia blanks, which had to be sintered to final density after milling, while with one system (Digident) restorations were directly milled from a fully sintered material. After manufacturing, horizontal and vertical marginal discrepancies, as well as the absolute marginal discrepancy, were determined by means of a replica technique. The absolute marginal discrepancy, which is considered to be the most suitable parameter reflecting restorations' misfit in the marginal area, had a mean value of 58  μ m for the Digident system. By contrast, mean absolute marginal discrepancies for the three other systems, processing presintered blanks, differed significantly and ranged between 183 and 206  μ m. Within the limitations of this study, it could be concluded that the marginal fit of zirconia FDPs is significantly dependent on the CAD/CAM system used, with restorations processed of fully sintered zirconia showing better fitting accuracy.     

Effect of digital impressions and production protocols on the adaptation of zirconia copings

Statement of problem

Proper marginal, axial, and occlusal adaptation of dental restorations is essential for their long-term success. Production protocols including digital impression systems have been developed, but little information is available on the adaptation of zirconia restorations produced via them.

Marginal and internal fit of metal copings fabricated with rapid prototyping and conventional waxing

Statement of problem

Given the limitations of conventional waxing, computer-aided design and computer-aided manufacturing (CAD-CAM) technologies have been developed as alternative methods of making patterns.

Evaluation of fracture resistance of inlay-retained fixed partial dentures fabricated with different monolithic zirconia materials

Statement of problem

Data are lacking on the fracture resistance of monolithic zirconia inlay-retained fixed partial dentures as a conservative treatment for a single missing tooth.

立体光固化成型氧化锆陶瓷的生物安全性评价

目的 评价立体光固化成型氧化锆陶瓷的生物安全性.方法 依照国标GB/T 16886.5—2017、GB/T 16886.10—2017及医药行业标准YY/T 0127.14—2009、YY/T 0127.13—2018对该陶瓷材料进行实验,包括体外细胞毒性实验、皮肤致敏实验、急性经口毒实验及黏膜刺激实验.结果 体外细胞...     

In vitro accuracy of digital and conventional impressions in the partially edentulous maxilla

Clinical Oral Investigations - This in vitro study compared the dimensional accuracy of conventional impressions (CI) with that of digital impressions (DI) in a partially edentulous maxilla. DIs...     

In vivo precision of conventional and digital methods for obtaining quadrant dental impressions

Objectives

Quadrant impressions are commonly used as alternative to full-arch impressions. Digital impression systems provide the ability to take these impressions very quickly; however, few studies have investigated the accuracy of the technique in vivo. The aim of this study is to assess the precision of digital quadrant impressions in vivo in comparison to conventional impression techniques.

Materials and methods

Impressions were obtained via two conventional (metal full-arch tray, CI, and triple tray, T-Tray) and seven digital impression systems (Lava True Definition Scanner, T-Def; Lava Chairside Oral Scanner, COS; Cadent iTero, ITE; 3Shape Trios, TRI; 3Shape Trios Color, TRC; CEREC Bluecam, Software 4.0, BC4.0; CEREC Bluecam, Software 4.2, BC4.2; and CEREC Omnicam, OC). Impressions were taken three times for each of five subjects (n = 15). The impressions were then superimposed within the test groups. Differences from model surfaces were measured using a normal surface distance method. Precision was calculated using the Perc90_10 value. The values for all test groups were statistically compared.

Results

The precision ranged from 18.8 (CI) to 58.5 μm (T-Tray), with the highest precision in the CI, T-Def, BC4.0, TRC, and TRI groups. The deviation pattern varied distinctly depending on the impression method. Impression systems with single-shot capture exhibited greater deviations at the tooth surface whereas high-frame rate impression systems differed more in gingival areas. Triple tray impressions displayed higher local deviation at the occlusal contact areas of upper and lower jaw.

Conclusions

Digital quadrant impression methods achieve a level of precision, comparable to conventional impression techniques. However, there are significant differences in terms of absolute values and deviation pattern.

Clinical relevance

With all tested digital impression systems, time efficient capturing of quadrant impressions is possible. The clinical precision of digital quadrant impression models is sufficient to cover a broad variety of restorative indications. Yet the precision differs significantly between the digital impression systems.