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Statement of problem Veneering with porcelain may adversely affect the marginal fit of long-span computer-aided design and computer-aided manufacturing (CAD-CAM) implant-supported fixed prostheses. Moreover, data regarding the precision of fit of CAD-CAM–fabricated implant-supported complete zirconia fixed dental prostheses (FDPs) before and after porcelain layering are limited. Purpose The purpose of this in vitro study was to evaluate the effect of porcelain layering on the marginal fit of CAD-CAM–fabricated complete-arch implant-supported, screw-retained FDPs with presintered zirconia frameworks compared with titanium. Material and methods An autopolymerizing acrylic resin–fixed complete denture framework prototype was fabricated on an edentulous typodont master model (all-on-4 concept; Nobel Biocare) with 2 straight in the anterior and 2 distally tilted internal-hexagon dental implants in the posterior with multiunit abutments bilaterally in canine and first molar locations. A 3-dimensional (3D) laser scanner (S600 ARTI; Zirkonzahn) was used to digitize the prototype and the master model by using scan bodies to generate a virtual 3D CAD framework. Five presintered zirconia (ICE Zirkon Translucent - 95H16; Zirkonzahn) and 5 titanium (Titan 5 - 95H14; Zirkonzahn) frameworks were fabricated using the CAM milling unit (M1 Wet Heavy Metal Milling Unit; Zirkonzahn).The 1-screw test was applied by fixing the frameworks at the location of the maxillary left first molar abutment, and an industrial computed tomography (CT) scanner (XT H 225 - Basic Configuration; Nikon) was used to scan the framework-model complex to evaluate the passive fit of the frameworks on the master model. The scanned data were transported in standard tessellation language (STL) from Volume Graphics analysis software to PolyWorks analysis software by using the maximum-fit algorithm to fit scanned planes in order to mimic the mating surfaces in the best way. 3D virtual assessment of the marginal fit was performed at the abutment-framework interface at the maxillary right canine (gap 3) and right first molar (gap 4) abutments without prosthetic screws. The facial or buccal aspects of the teeth on frameworks were layered with corresponding porcelain (Initial Dental Ceramic System; GC) and CT-scanned again using the same protocol. Marginal fit measurements were made for 4 groups: titanium (Ti) (control), porcelain-layered titanium (Ti-P) (control), zirconia (Zr), and porcelain-layered zirconia (Zr-P). 3D discrepancy mean values were computed and calculated, and the results were analyzed with a repeated measures 3-way ANOVA using the maximum likelihood estimation method and Bonferroni adjustments for selected pairwise comparison t- tests (α=.05). Results The 3D fit was measured at gap 3 and gap 4. Statistically significant differences in mean 3D discrepancies were observed between Zr-P (175 μm) and Zr (89 μm) and between Zr-P and Ti-P (71 μm) ( P Conclusions Porcelain layering had a significant effect on the marginal fit of CAD-CAM–fabricated complete-arch implant-supported, screw-retained FDPs with partially sintered zirconia frameworks. 3D marginal discrepancy mean values for all groups were within clinically acceptable limits (

Statement of the Problem: Management of severe occlusal erosive lesions constitutes a challenging therapeutic approach to the restorative dentist. Bonded occlusal veneers have been introduced as a conservative solution to traditional onlays or complete coverage crowns. Still, there is lack of information and conflict in the data concerning the mechanical performance of the occlusal veneer materials and designs.Purpose: The purpose of this in vitro investigation was to evaluate and compare the fracture resistance and failure mode of a newly proposed occlusal veneer design constructed of zirconia reinforced lithium silicate and hybrid ceramic materials with the conventional design restored with the same tested materials.Materials and Methods: Two mandibular first molars of a typodont were chosen to perform the master preparations; one for the conventional planar occlusal veneer design, and the second for the proposed modified design which consisted of occlusal veneer preparation with circumferential chamfer finish line and two shallow proximal slots. Ten elastomeric impressions were taken for each design using the putty and light polysiloxane addition silicone impression material. The twenty impressions were poured using type IV dental stone to produce twenty stone casts, ten for each design. Each group of stone casts was subdivided randomly into two equal subgroups according to the ceramic material to be tested; the zirconia reinforced lithium silicate “Celtra Duo” and the hybrid resin nano ceramic “Lava Ultimate”. All the occlusal veneers were fabricated using the CAD/CAM Cerec InLab SW 4.2.5 System. The veneers were then checked on both the stone casts and the master preparation on the typodont for perfect seating, after the Celtra veneers were crystallized and glazed and the Lava veneers being subjected to finishing and polishing. The preparations were duplicated to obtain twenty epoxy casts over which the occlusal veneers were adhesively cemented using a standard bonding protocol. The samples were then subjected to thermal cycling program. All the samples were individually mounted on the Instron testing machine with a loadcell of 5 KN and fracture test was done by compressive mode of load applied occlusally using a metallic rod with spherical tip (5.6 mm diameter) at cross-head speed of 1mm/min. The load required to fracture was recorded in Newton and tabulated to be statistically analyzed. The fractured specimens were examined to detect the mode of failure. Results: Regardless of the ceramic type, the modified occlusal veneer design showed statistically significant higher fracture resistance mean value (1106.0 N) than conventional design (957.6 N) at P ≤ 0.05. Irrespective of the design, the Lava Ultimate revealed higher statistically significant fracture resistance mean value (1114.1 N) than Celtra (949.5 N) at P ≤ 0.05. The Celtra veneers showed higher fracture resistance mean value (1016.9N) with the conventional design than the modified design (882.2 N), the difference was statistically significant at P ≤ 0.05. While the lava veneers presented higher statistically significant fracture resistance mean value with the modified design (1329.9 N) than the conventional design (898.3 N) at P ≤ 0.05. All the specimens exhibited cracks limited to the veneer material, except one revealed catastrophic failure.Conclusions: 1- The modified occlusal veneer design offered promising results as far as fracture resistance is concerned particularly with the nano-hybrid ceramic which presented the highest statistically significant fracture resistance mean values.2- The conventional planar occlusal veneer design proved to be superior with zirconia lithium silicate ceramic (ZLS) as it presented highly significant fracture resistance mean values than with the modified design.3- Both the conventional and modified occlusal veneer designs presented fracture resistance mean values with the two tested materials “Celtra and Lava Ultimate” that exceed the range of clinical acceptability.4- Rating of the tested occlusal veneers according to their fracture resistance mean values is as follows: the highest for the Lava Ultimate with the modified design, followed by Celtra Duo with conventional design, then Lava Ultimate with conventional design and Celtra Duo with modified design.5- It can be recommended that in cases with increased occlusal stresses, Lava Ultimate occlusal veneer with the modified design be the first choice, followed by the Celtra Duo with the conventional design as a second choice.

Statement of the problem: researches studying the accuracy of the 3D printed dies were very rare.Aim: The aim of the current study was to assess the difference in accuracy and reproducibility of the three dimensionally printed dies versus the stone dies.Materials& Methods: A maxillary typodont (D13PP-TR.1; Nissan, Kyoto, Japan) model with missing upper 1st molar was prepared as master model. Two types of dies were obtained from the master model (n=6). Group 1 was the conventional stone dies using type IV stone (GC FujiRock EP; GC) while group 2 representing the 3D printed dies (Dent2 Mogassam LLC Co. Egypt, Cairo) using resin (industrial blended resin, Funtodo Co. Netherlands). All working models were scanned (Open Technologies 3D scanner, Brescia, Italy) and STL file was superimposed on the STL file of the master model with the best-fit alignment method to analyze the volumetric changes and color maps were provided using 3Shape 3D software software. The mean average distance between the master dies and the working dies in all groups was recorded. Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. Quantitative data were explored for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests. Results: There were no statistically significant differences in volumetric discrepancies between stone model (0.186±0.231) mm3 as a (mean±SD) and 3D printed model (0.176±0.211) mm3 as a mean±SD. Conclusion: Digital work flow can eventually replace the conventional techniques with minimal volumetric discrepancies in 3D printed dies.

Despite the increasing demand for a digital workflow in the fabrication of indirect restorations, information on the accuracy of the resulting definitive casts is limited.The purpose of this in vitro study was to compare the accuracy of definitive casts produced with digital scans and conventional impressions.Chamfer preparations were made on the maxillary right canine and second molar of a typodont. Subsequently, 9 conventional impressions were made to produce 9 gypsum casts, and 9 digital scans were made to produce stereolithography additive (SLA) casts from 2 manufacturers: 9 Dreve SLA casts and 9 Scanbiz SLA casts. All casts were then scanned 9 times with an extraoral scanner to produce the reference data set. Trueness was evaluated by superimposing the data sets obtained by scanning the casts with the reference data set. Precision was evaluated by analyzing the deviations among repeated scans. The root mean square (RMS) and percentage of points aligned within the nominal values (±50 μm) of the 3-dimensional analysis were calculated by the software.Gypsum had the best alignment (within 50 μm) with the reference data set (median 95.3%, IQR 16.7) and the least RMS (median 25.8 μm, IQR 14.6), followed by Dreve and Scanbiz. Differences in RMS were observed between gypsum and the SLA casts (P.001). Within 50 μm, gypsum was superior to Scanbiz (P.001). Gypsum casts exhibited the highest precision, showing the best alignment (within 50 μm) and the least RMS, followed by Scanbiz and Dreve.This study found that gypsum casts had higher accuracy than SLA casts. Within 50 μm, gypsum casts were better than Scanbiz SLA casts, while gypsum casts and Dreve SLA casts had similar trueness. Significant differences were found among the investigated SLA casts used in the digital workflow.

Objective: The purposes of this study were to present a prototype of a bracket-positioning gauge, which makes vertical inclination of the instrument difficult, allowing a reduction of vertical bracket positioning error, and to test its accuracy in bracket positioning by groups of individuals with different clinical experience and in specific groups of teeth. Methods: For the testing of the prototype, four groups of six participants each were used: Group 1 was composed of undergraduate students in the dental school, who had no previous experience in bonding orthodontic attachments; Group 2 was composed of orthodontic graduate students in the dental school; Group 3 consisted of orthodontists with a maximum of 5 years of clinical experience; Group 4 comprised orthodontists with more than 5 years of clinical experience. A typodont was simulated with a Class I crowded malocclusion, which reproduced the same occlusal characteristics for all groups to be bonded. All participants were instructed to bond 0.022×0.028-in Edgewise brackets on the labial surfaces of the upper and lower incisors, canines, and premolars at a height of 4 mm from the incisal edge or the labial cusp tip. Results: Only the mean value of Group 1 showed statistically significant difference in the comparison with the standard measurement. In the groups of teeth, the difference was significant for the premolar and incisor groups. Conclusion: Clinical experience interfered with the accuracy of vertical positioning of orthodontic attachments. As for the groups of teeth, premolars, followed by canines and incisors had the closest mean values to the standard measurement. RESUMO Objetivos: os objetivos deste estudo foram apresentar um protótipo de posicionador de braquetes ortodônticos que dificulte a inclinação no sentido vertical, possibilitando a redução dos erros de altura no posicionamento desses acessórios; além de testar sua precisão na colagem, realizada por grupos de indivíduos com diferentes tempos de experiência clínica em Ortodontia e em grupos específicos de dentes. Métodos: para os testes do protótipo desenvolvido, quatro grupos de seis participantes foram formados. O Grupo 1 foi composto por alunos do curso de Odontologia sem qualquer prática com colagem em Ortodontia; o Grupo 2, por estudantes em Ortodontia; o Grupo 3, por ortodontistas com menos de cinco anos de experiência clínica; e o Grupo 4, por ortodontistas com mais de cinco anos de experiência clínica em Ortodontia. Em um typodont, foi simulada uma má oclusão Classe I com apinhamento, com as mesmas características para todas as colagens realizadas. Todos os participantes foram instruídos a colar braquetes Edgewise 0,022” x 0,028” na superfície vestibular dos incisivos, caninos e pré-molares superiores e inferiores, na altura de 4mm da borda incisal ou cúspide vestibular. Resultados: somente a média do Grupo 1 apresentou diferença estatisticamente significativa na comparação com a medida padrão. Nos grupos de dentes, a diferença foi significativa para o grupo dos pré-molares e incisivos. Conclusão: o tempo de experiência clínica interferiu na precisão do posicionamento vertical do acessório ortodôntico e, quanto aos grupos de dentes, as médias mais próximas à medida padrão foram dos pré-molares, seguidas pelos caninos e incisivos.

The manufacturers of computer-aided design and computer-aided manufacturing (CAD-CAM) systems emphasize that new technologies can improve the marginal fit of dental crowns. However, data supporting this claim are limited.The purpose of this in vitro study was to investigate the differences among the following fabrication methods on the marginal discrepancy of dental crowns: intraoral optical scanners, powder application, and adjustments of intaglio surface.A single human premolar was fixed on a typodont and prepared to receive crowns prepared by the CEREC CAD-CAM system. Three fabrication techniques were used: digital scans using the CEREC Bluecam scanner with titanium dioxide powder (TDP), digital scans using the CEREC Omnicam scanner without TDP, and digital scans using the Omnicam scanner with TDP. Five experimental groups (n=10) were designated: Bluecam (group B), Bluecam with adjustments (group BA), Omnicam (group O), Omnicam with adjustments (group OA), and Omnicam with TDP (group OP). The specimens were scanned using microcomputed tomography to measure the vertical, horizontal, and internal fit and volumetric 3-dimensional (3D) internal fit values of each luting space. The paired t test was used to evaluate mean marginal fit change after adjustments within the same group. One-way analysis of variance and post hoc tests were used to compare groups B, O, and OP (α=.05).Mean vertical fit values ±standard deviations of group B=29.5 ±13.2 μm; BA=26.9 ±7.7 μm; O=149.4 ±64.4 μm; OA=49.4 ±12.7 μm; and OP=33.0 ±8.3 μm. Adjustments in the intaglio surface and TDP application statistically influenced the vertical fit of group O (P.001). The percentage of vertical fit values 75 μm in group B=89.3%, BA=92.7%, O=31.0%, OA=73.5%, and OP=92.0%. Mean horizontal fit values for group B=56.2 ±21.5 μm; 85.8 ±44.4 μm for group BA; 77.5 ±11.8 μm for group O; 102.5 ±16.2 μm for group OA; and 91.4 ±19.4 μm for group OP. Results from group B were significantly different from those of the other test groups (P.05). The percentages of horizontal misfit were 61.2% in group B; 73.5% in group BA; 88.1% in group O; 92.4% in group OA; and 85.0% in group OP. Volumetric 3D internal fit values in group B were 9.4 ±1.3 mmDifferent intraoral optical scanners, powder application, and internal adjustments influenced the marginal discrepancy of crowns. Crowns fabricated using the Omnicam system had significantly higher vertical discrepancy and volumetric 3D internal fit than those fabricated using the Bluecam scanner with TDP. Adjustments of the intaglio surface improved the vertical fit of crowns made using the Omnicam scanner; however, TDP application before Omnicam scanning improved the vertical fit as well as the volumetric 3D internal fit value of the luting space of crowns.

Objective Clinicians have been slow to adopt digital impression technologies due possibly to perceived technique sensitivities involved in data acquisition. This research has two aims: determine whether scan pattern and sequence affects the accuracy of the three-dimensional (3D) model created from this digital impression and to compare the 5 imaging systems with regards to their scanning accuracy for sextant impressions. Materials and methods Six digital intraoral impression systems were used to scan a typodont sextant with optical properties similar to natural teeth. The impressions were taken using five different scan patterns and the resulting digital models were overlayed on a master digital model to determine the accuracy of each scanner performing each scan pattern. Furthermore, regardless of scan pattern, each digital impression system was evaluated for accuracy to the other systems in this same manner. Results No differences of significance were noted in the accuracy of 3D models created using six distinct scan patterns with one exception involving the CEREC Omnicam. Planmeca Planscan was determined to be the truest scanner while 3Shape Trios was determined to be the most precise for sextant impression making. Conclusions Scan pattern does not significantly affect the accuracy of the resulting digital model for sextant scanning. Clinical significance Companies who make digital impression systems often recommend a scan pattern specific for their system. However, every clinical scanning scenario is different and may require a different approach. Knowing how important scan pattern is with regards to accuracy would be helpful for guiding a growing number of practitioners who are utilizing this technology.

Purpose: To evaluate the influence of fabrication method and finish line design on marginal and internal fit of full-coverage interim restorations. Methods: Four typodont models of maxillary central-incisor were prepared for full-coverage restorations. Four groups were defined; knife-edge (KE), chamfer (C), rounded-shoulder (RS), rounded-shoulder with bevel (RSB). All preparations were digitally scanned. A total of 80 restorations were fabricated; 20 per group (SLA/3D-printed n = 10, milled n = 10). All restorations were positioned on the master die and scanned using micro-computed tomography. The mean gaps were measured digitally (ImageJ). The results were compared using MANOVA (α =.05). Results: Internal and marginal gaps were significantly influenced by fabrication method (P =.000) and finish-line design (P =.000). 3D-Printed restorations showed statistically significant lower mean gap compared to milled restorations at all points (P =.000). The mean internal gap for 3D-printed restorations were 66, 149, 130, 95 μm and for milled restorations were 89, 177, 185, 154 μm for KE, C, RS, RSB respectively. The mean absolute marginal discrepancy in 3D-printed restorations were (30, 41, 30, 28 μm) and in milled restorations were (56, 54, 52, 38 μm) for KE, C, RS, RSB respectively. Conclusions: The fabrication methods showed more of an influence on the fit compared to the effect of the finish-line design in both milled and printed restorations. SLA-printed interim restorations exhibit lower marginal and internal gap than milled restorations. Nonetheless, for both techniques, all values were within the reported values for CAD/CAM restorations. Significance: 3D-printing can offer an alternative fabrication method comparable to those of milled restorations.

Objectives Magnets have many advantages in orthodontics, and our previous studies confirmed their therapeutic potential through 3D-data analysis. The aim of this study was to compare tooth movements, including rotation, obtained via magnetic and elastic forces in crowded cases in vitro. Methods Typodont models mimicking a crowded case were prepared. In the magnetic force-driven orthodontics (MG) group, Nd-Fe-B magnets were attached to the labial surfaces from UR4 to UL4 for attracting force, and to UR6 and UL6 for repulsing force. For the elastic force-driven orthodontic (EL) group, brackets were placed on labial surfaces from UR2 to UL2 with power-chain elastics. A NiTi archwire was used in both groups. The models were 3D scanned before and after tooth movement and exported as STL files. The pre- and post-movement STL files were superimposed. The 3D coordinates of the measurement points of the crown and root apex were obtained, and tooth displacement, 3D movements (X, Y, and Z-axis), and rotation (yaw, pitch, and roll) were calculated. Two-tailed Student's t-test was performed for comparison of the results between MG and EL groups (n = 3). Results Overall, both groups indicated similar movement and rotation to achieve the planned arch form. In the crown movement and rotation, no significant differences were observed between MG and EL groups. However, in the root movement, there was a significant difference between MG and EL groups in X and Z axis for the canines. Conclusions Magnetic force-driven orthodontics demonstrated comparable results to elastics with less tipping movement, suggesting a potential future orthodontic modality. Clinical significance This in vitro study showed the potential of magnetic force for orthodontic application. The magnetic force-driven orthodontics might provide less tipping tooth movement compared to conventional methods, such as power chains, and could be a future technique for comprehensive orthodontic treatment., Magnets; Elastics; CAD/CAM; Orthodontics; 3D printer; 3D scanner.

Suboptimal adaptation of fixed dental prostheses (FDPs) can lead to technical and biological complications. It is unclear if the computer-aided design/computer-aided manufacturing (CAD/CAM) technique improves adaptation of FDPs compared with FDPs made using the lost-wax and metal casting technique. Three-unit FDPs were manufactured by CAD/CAM based on digital impression of a typodont model. The FDPs were made from one of five materials: pre-sintered zirconium dioxide; hot isostatic pressed zirconium dioxide; lithium disilicate glass-ceramic; milled cobalt-chromium; and laser-sintered cobalt-chromium. The FDPs made using the lost-wax and metal casting technique were used as reference. The fit of the FDPs was analysed using the triple-scan method. The fit was evaluated for both single abutments and three-unit FDPs. The average cement space varied between 50 μm and 300 μm. Insignificant differences in internal fit were observed between the CAD/CAM-manufactured FDPs, and none of the FPDs had cement spaces that were statistically significantly different from those of the reference FDP. For all FDPs, the cement space at a marginal band 0.5-1.0 mm from the preparation margin was less than 100 μm. The milled cobalt-chromium FDP had the closest fit. The cement space of FDPs produced using the CAD/CAM technique was similar to that of FDPs produced using the conventional lost-wax and metal casting technique.

Many clinicians use hand screwdrivers to tighten prosthetic and abutment screws. The impact of the screwdriver type, the location of the implant, and the sex of the practitioner on the generated torque is not well understood.The purpose of this in vitro study was to compare the torque generated by different hand screwdrivers when used in the anterior and posterior regions and to evaluate the correlation between the applied torque and the sex and body mass index (BMI) of the practitioner.A mandibular typodont with anterior and posterior implants was mounted in a mannequin head. Fifty clinicians (6 prosthodontists, 8 graduate prosthodontic students, and 36 dental students) used their maximum force to tighten the abutment screws in the anterior and posterior regions, using 3 different hand screwdrivers, with handles of different shapes and sizes (small, medium, and large). The torque values generated were measured using torque meters connected to the implants. The generated torque, sex, age, height, and weight were also recorded for each clinician. A generalized linear model was used to find correlations between the different factors and the generated torque (α=.05).Significant differences were observed among the applied torque values when different screwdrivers were used (P.001). Higher torque values were generated in the anterior region than in the posterior region (P.001). The interaction of the sex and BMI of the participants significantly affected the generated torque values (P=.044).The type of screwdriver and location of the implant affected the generated torque. Torque values generated by the large screwdriver were higher than those of small and medium screwdrivers. Higher torque was applied in the anterior region.

PURPOSE To compare the marginal fit of lithium disilicate (LD) crowns fabricated with digital impression and manufacturing (DD), digital impression and traditional pressed manufacturing (DP), and traditional impression and manufacturing (TP). MATERIALS AND METHODS Tooth #15 was prepared for all-ceramic crowns on an ivorine typodont. There were 45 LD crowns fabricated using three techniques: DD, DP, and TP. Microcomputed tomography (micro-CT) was used to assess the 2D and 3D marginal fit of crowns in all three groups. The 2D vertical marginal gap (MG) measurements were done at 20 systematically selected points/crown, while the 3D measurements represented the 3D volume of the gap measured circumferentially at the crown margin. Frequencies of different marginal discrepancies were also recorded, including overextension (OE), underextension (UE), and marginal chipping. Crowns with vertical MG > 120 μm at more than five points were considered unacceptable and were rejected. The results were analyzed by one-way ANOVA with Scheffe post hoc test (α = 0.05). RESULTS DD crowns demonstrated significantly smaller mean vertical MG (33.3 ± 19.99 μm) compared to DP (54.08 ± 32.34 μm) and TP (51.88 ± 35.34 μm) crowns. Similarly, MG volume was significantly lower in the DD group (3.32 ± 0.58 mm3 ) compared to TP group (4.16 ± 0.59 mm3 ). The mean MG volume for the DP group (3.55 ± 0.78 mm3 ) was not significantly different from the other groups. The occurrence of underextension error was higher in DP (6.25%) and TP (5.4%) than in DD (0.33%) group, while overextension was more frequent in DD (37.67%) than in TP (28.85%) and DP (18.75%) groups. Overall, 4 out of 45 crowns fabricated were deemed unacceptable based on the vertical MG measurements (three in TP group and one in DP group; all crowns in DD group were deemed acceptable). CONCLUSION The results suggested that digital impression and CAD/CAM technology is a suitable, better alternative to traditional impression and manufacturing.

PURPOSE This in vitro study aimed to analyze and compare the reproducibility of zirconia and lithium disilicate crowns manufactured by digital workflow. MATERIALS AND METHODS A typodont model with a prepped upper first molar was set in a phantom head, and a digital impression was obtained with a video intraoral scanner (CEREC Omnicam; Sirona GmbH), from which a single crown was designed and manufactured with CAD/CAM into a zirconia crown and lithium disilicate crown (n=12). Reproducibility of each crown was quantitatively retrieved by superimposing the digitized data of the crown in 3D inspection software, and differences were graphically mapped in color. Areas with large differences were analyzed with digital microscopy. Mean quadratic deviations (RMS) quantitatively obtained from each ceramic group were statistically analyzed with Student's t-test (α=.05). RESULTS The RMS value of lithium disilicate crown was 29.2 (4.1) µm and 17.6 (5.5) µm on the outer and inner surfaces, respectively, whereas these values were 18.6 (2.0) µm and 20.6 (5.1) µm for the zirconia crown. Reproducibility of zirconia and lithium disilicate crowns had a statistically significant difference only on the outer surface (P

Objective This study aimed to evaluate the ability of the proposed technique in producing restorations that exhibit mimesis with tooth structure and to define a restorative clinical protocol. Materials and Methods For this study a typodont was used. The right upper central incisor with Class IV lesion was restored with the layering technique (reference tooth, RT). For the left upper central incisor with Class IV lesion, six teeth were restored monochromatically (test teeth, TT), using DA3.5 (n = 3) and DA4 (n = 3) composite resins—resulting in six unsatisfactory color restorations. TT were divided into six groups depending on the color of unsatisfactory restoration and preparation depth. First, a preparation was realized on the labial surface with 0.5 mm, 0.7 mm or 1.0 mm of depth. A second preparation was then performed to reproduce the dentinal mamelons. Next, adhesive procedures were performed and the teeth restored. Opaque halo, opalescent halo and vestibular enamel were then reproduced by the addition of different composite resins. The RT and TT were photographed side by side in typodont to obtain six photographic prints. The photographs of the groups were subjected to visual evaluation by 120 volunteers via a questionnaire. Data were analyzed by the prevalence of answers, and Chi-square test was used to investigate the association between variables at .05 significance. Furthermore, ΔE of groups was evaluated in comparison RT. Results The results demonstrated that the moderate intensity restorations (DA3.5) with depths of 0.5 mm and 0.7 mm had the highest prevalence of acceptance. For severe intensity restorations (DA4), the preparation depth of 1.0 mm obtained better acceptance. Conclusions The technique was able to modify the final color of Class IV restorations, producing satisfactory color restorations. CLINICAL SIGNIFICANCE This technique can be used for color correction in cases of Class IV restorations, in situations where there is no time for immediate layered restoration, and as a restorative technique.

Purpose Recently, we developed glass fiber-reinforced plastic (GFRP) orthodontic wire made from polycarbonate and E-glass fiber. The purpose of this study was to investigate the utility of GFRP wire in a clinical orthodontic treatment setting, the typodont model was simulated with a Class I malocclusion and mild crowding (arch length discrepancy: 4.5 mm). Materials and methods GFRP round wire with a diameter of 0.45 mm (0.018 in.) was prepared using 7 μm glass fibers. As control, nickeltitanium (Ni–Ti: 0.018 inch) alloy was also evaluated. For both wire groups, we examined the difference the arch widh and the arch length in the maxillary and mandibular using superimposition of 3D virtual models before and after immersion in typodont model. We also examined the strain force and permanent deformation. Results The inclination toward the labial aspect and the major axis of the upper and lower incisors increased, respectively, after the experiment. No significant differences before and after treatment were noted between the wires. On comparing the strain force of both wires after ligating the wire (4 weeks) in the strain test, the force of the GFRP wire was slightly lower than that of the Ni–Ti wires. In addition, there was more permanent deformation in the GFRP wire than in the Ni–Ti wire (P Conclusion GFRP wire showed equivalent efficiency to that of commercial Ni–Ti wire in improving mild anterior crowding in a typodont experiment. Therefore, GFRP wire can be used in place of Ni–Ti wire during the initial leveling stage.

Purpose To evaluate the marginal gaps of CAD/CAM (CEREC 3) produced crowns made from leucite-reinforced glass-ceramic (IPS Empress CAD) blocks (LG), and lithium-disilicate (IPS e.max CAD) blocks before (LD-B), and after (LD-A) crystallization firing. Materials and Methods A human molar tooth (#19) was mounted with adjacent teeth on a typodont and prepared for a full-coverage ceramic crown. The typodont was assembled in the mannequin head to simulate clinical conditions. After tooth preparation 15 individual optical impressions were taken by the same operator using titanium dioxide powder and a CEREC 3 camera per manufacturer's instructions. One operator designed and machined the crowns in leucite-reinforced glass-ceramic blocks (n = 5) and lithium-disilicate blocks (n = 10) using the CEREC 3 system. The crowns were rigidly seated on the prepared tooth, and marginal gaps (μm) were measured with an optical microscope (500×) at 12 points, 3 on each of the M, B, D, and L surfaces of the leucite-reinforced glass-ceramic crowns and the lithium-disilicate crowns before and after crystallization firing. Results were analyzed by two-way ANOVA followed by a Tukey's post hoc multiple comparison test (α = 0.05). Results The overall mean marginal gaps (μm) for the crowns evaluated were: LG = 49.2 ± 5.5, LD-B = 42.9 ± 12.2, and LD-A = 57.2 ± 16.0. The marginal gaps for LG and LD-B were not significantly different, but both were significantly less than for LD-A. Conclusions The type of ceramic material did not affect the marginal gap of CAD/CAM crowns. The crystallization firing process required for lithium-disilicate crowns resulted in a significant increase in marginal gap size, likely due to shrinkage of the ceramic during the crystallization process. Clinical Relevance: The marginal gap of CAD/CAM-fabricated lithium disilicate crowns increases following crystallization firing. The marginal gap still remains within clinically acceptable parameters.

Purpose: Evaluate and compare the effect of using die spacer on marginal accuracy and fit of indirectly fabricated temporary restorations using silicone model material and stone dies. Problem statement: Chairside temporary restorations fabricated by the direct method commonly show binding on seating, or short margins or premature contacts after temporary cementation. Temporary restorations are fabricated without spacer which may compromise the fit. Therefore it would be an advantage to provide adequate internal fitting space to optimize marginal adaptation.Methodology: Master die was typodont .Maxillary first molar was manually prepared as in an actual clinical situation. A vacuu-pressed tooth index was made before preparation to standardize the dimension of the temporary restoration. A total of twenty temporary crowns were fabricated from autopolymerizing Bis-acryl resin material and divided into two groups according to the model material used (n=10) stone (Fuji rock; type IV die stone, GC & Modellsilikon, VOCO GmbH, Cuxhaven, Germany) poured from alginate impressions. Each group was subdivided into two subgroups according to spacer used; with and without spacer (n=5). Two coats (approximately 30 µm) were painted on the dies. All the fabricated temporary restorations were visually examined internally and verified for complete seating on its corresponding die. Seating and fit of each crown were evaluated on the master die and were stored in distilled water overnight till testing took place. Margins were inspected and photographed under magnification of 45X using USB Digital microscope measurements. The generated data was statistically analyzed. The significance level was set at P ≤ 0.05Results: There was no statistically significant difference between vertical marginal gap distances in the two groups; (79.9+15.0 µm) (66.4+10.0 µm) without spacer and with spacer respectively at P ≤ 0.05Conclusion & Clinical implications: Despite that the resulted difference in gap is insignificant however painting spacer seems to provide better cement escape vent thus easing fit, also the use of silicone model material offers a practical, speedy and simplified method to conveniently fabricate a good fitting temporary restoration.

Background/purpose One of the major educational goals in preclinical dental education is to learn tooth preparation techniques. The purpose of this study was to evaluate the influence of different preparation designs on the development of the manual dexterity of students, in order to perform a state-of-the-art tooth preparation. Material and methods Seventy-two 1 st semester students were divided into two groups and educated in tooth preparation for a ceramic anterior single crown. One group received cylindrical burs with a rounded edge to prepare a typodont model with a shoulder finishing line, while the other group had cylindrical burs with round noses to prepare a chamfer finishing line. All preparations were digitized and evaluated using special software focusing on the parameters of preparation depth and preparation angle. In addition, violation of the adjacent teeth was estimated. Data was statistically evaluated at a level of significance of 5%. Results The preparation design used did not show a statistically significant influence on the preparation depth or on the preparation angle. A trend to a higher tooth structure removal as required was detected. Furthermore, no influence of the type of preparation design on the number of violated adjacent teeth was found. Conclusion In preclinical dental education, the type of preparation design was found to have no influence on the measured parameters representing the quality of the preparation.

Objective This in vitro study aims to evaluate load-to-failure of ceramic veneers with butt joint (BJ) and feathered edge (FE) incisal preparation designs, and to correlate these results to the failure mode of the restorations. Materials and methods One hundred and forty-eight typodont teeth (customized Nissin A25A-UL19B) were divided into two different preparation configurations BJ and FE and two different loading angulations, 0° and 20°. Lithium disilicate ceramic veneers (IPS e.max CAD, Ivoclar Vivadent) were milled using computer-aided-design-and-computer-aided-manufacturing (CAD/CAM) techniques. Veneers were bonded to typodont teeth with resin cement (IPS Variolink Esthetic, Ivoclar Vivadent). Each group was loaded at the incisal edge using an Instron Universal Testing Machine at a crosshead speed of 0.01 mm/s till failure. Results Pairwise comparison showed veneers from the BJ groups had a significantly higher load-to-failure value compared to the FE groups. Veneers with a FE preparation design loaded at 20° angulation had the lowest load-to-failure value. Conclusions Within the limitations of the present study, both incisal preparation designs and loading angulations have significant effects on the load-to-failure values of ceramic veneers. BJ group exhibits a significantly higher load-to-failure value compared to the FE group. Clinical significance BJ incisal preparation is preferred over FE preparation design.

PURPOSE This study compared the marginal gaps of computer-aided design/computer-aided manufacture (CAD/CAM)-fabricated all-ceramic crowns constructed from scanned impressions and models and with two different occlusal reduction designs. MATERIALS AND METHODS Two typodont mandibular first molars were prepared to receive CAD/CAM-fabricated all-ceramic crowns. Both molars were prepared to ideal crown reduction, the first with anatomical occlusal reduction (AOR) and the second with completely flat occlusal reduction (FOR). Nine polyvinyl siloxane impressions (PVS) were taken, and nine stone replicas fabricated for each preparation. All impressions and stone models were scanned using a laser scanner (Planmeca Planscan, E4D technologies), and 36 lithium disilicate (IPS e.max CAD) crowns were milled. The marginal gap was measured in four locations using a light stereomicroscope. RESULTS Crowns constructed from preparations with both occlusal reduction designs demonstrated similar marginal gaps (FOR = 97.98; AOR = 89.12; P = .739). However, all crowns constructed from scanned impressions presented significantly larger marginal gaps than the crowns fabricated from scanned models (impressions = 109.26; models = 77.84; P = .002). CONCLUSION Scanning stone models produced all-ceramic crowns with significantly smaller marginal gaps than scanning impressions, irrespective of the occlusal reduction design.

PURPOSE This study compared the marginal gaps of computer-aided design/computer-aided manufacture (CAD/CAM)-fabricated all-ceramic crowns constructed from scanned impressions and models and with two different occlusal reduction designs. MATERIALS AND METHODS Two typodont mandibular first molars were prepared to receive CAD/CAM-fabricated all-ceramic crowns. Both molars were prepared to ideal crown reduction, the first with anatomical occlusal reduction (AOR) and the second with completely flat occlusal reduction (FOR). Nine polyvinyl siloxane impressions (PVS) were taken, and nine stone replicas fabricated for each preparation. All impressions and stone models were scanned using a laser scanner (Planmeca Planscan, E4D technologies), and 36 lithium disilicate (IPS e.max CAD) crowns were milled. The marginal gap was measured in four locations using a light stereomicroscope. RESULTS Crowns constructed from preparations with both occlusal reduction designs demonstrated similar marginal gaps (FOR = 97.98; AOR = 89.12; P = .739). However, all crowns constructed from scanned impressions presented significantly larger marginal gaps than the crowns fabricated from scanned models (impressions = 109.26; models = 77.84; P = .002). CONCLUSION Scanning stone models produced all-ceramic crowns with significantly smaller marginal gaps than scanning impressions, irrespective of the occlusal reduction design.

With the introduction of rare earth magnets like neodymium-iron-boron (NdFeB), it has become possible to produce small magnets with high forces, necessary for its usage in the field of dentistry, such as for orthodontic tooth movement. The ultimate goal of this project is to establish magnetic force-driven orthodontic treatment as a future treatment modality for comprehensive orthodontic treatment. In order to utilize magnets for orthodontic treatment, we must first understand the characteristics of tooth movement created by magnetic forces. In this study, we aimed to digitally assess the efficacy of magnetic attraction and repulsion forces by means of a 3D digital analysis of movement (distance, direction, angulation and duration) and rotation (yaw, pitch and roll) of the crown and root of teeth in an ex vivo typodont model. We performed space closure and space gain treatment of maxillary central incisors (n = 30) and analyzed the movement and rotation of the teeth and root apex with 3D digital analysis. The results of the typodont model indicated significant differences on amount, speed and rotation of tooth and root movement created by magnetic attraction and repulsion forces. We also mimicked a moderate crowding typodont case and successfully treated it with a combination of attraction and repulsion magnetic forces. The moderate crowding case utilized magnets and a titanium archwire to guide the planned tooth movements and prevent undesired or unexpected movement. Further ex vivo experiments and considerations for biosafety will be necessary to investigate magnet force-driven orthodontics as a future modality of orthodontic treatment., Dentistry; Dental materials; Medical imaging; Health technology;Magnetic forces; NdFeB magnets; Orthodontic tooth movements; Force control

PURPOSE To evaluate the accuracy of three-dimensional (3D) printed models manufactured using two different printer technologies with different model base designs. MATERIALS AND METHODS A maxillary typodont was scanned using a desktop scanner to generate the Standard Tessellation Language (STL) file as a reference scan. After the scanning procedure, the STL file was exported to Model Builder™ for designing the following two types of the model bases: a solid base design and a hollow base design with a 2.0 mm thickness of the external shell. Each design was printed to produce 10 models using a Continuous Liquid Interface Production (CLIP) printer and a Digital Light Processing (DLP) printer. The following four groups were tested: CLIP with solid base (CS); CLIP with hollow base (CH); DLP with solid base (DS); and DLP with hollow base (DH). A total of 40 models were scanned using the same desktop scanner to generate the STL files for evaluation of the accuracy by evaluation of trueness and precision. All STL files were superimposed with the control STL file via surface matching software and a comparison was performed using the 3D color mapping function and a 2D comparison of 48 points selected on the tested model. The data were collected by measuring the deviation between the tested model and the reference scan. Trueness was calculated by using the comparison among four tested groups. The Kruskal-Wallis analysis was conducted to assess the overall statistical significance of differences among the tested groups (α = 0.05). For precision measurement, the evaluation was conducted using Intraclass Correlation Coefficient (ICC) value at 95% confident interval to determine the deviation within the same tested groups. RESULTS The median values for the deviated distance of the four tested groups were 0.045 (CH), 0.035 (CS), 0.077 (DH), and 0.077 mm (DS). There were no statistically significant differences between the trueness of the two groups when using the same printers regardless of the designs of model base (p > 0.05). However, when comparing the two printers using the same model base design and the two different designs of model base, there were statistically significant differences in trueness (p

Additively manufactured dental casts are gaining popularity as the digital workflow is adopted in dentistry. However, studies on their dimensional accuracy and stability under different storage conditions in the dental laboratory are lacking.The purpose of this in vitro study was to compare the effects of different additive manufacturing processes and storage conditions on the dimensional accuracy and stability of 3D-printed dental casts.A completely dentate maxillary typodont model was digitized 10 times with a dental laboratory laser scanner, and the standard tessellation language (STL) files were used to manufacture 3D-printed diagnostic casts with the digital light projection (DLP) 3D printer (Asiga MAX) and material jetting (MJ) 3D printer (ProJet 3510 DPPro). Twenty DLP-printed and 20 MJ-printed diagnostic casts were digitized within 24 hours of production. Subsequently, all 3D-printed diagnostic casts were stored for 3 months, either in closed laboratory boxes or in dental laboratory open-face plastic containers with direct exposure to full-spectrum balanced light. After 3-month storage, all 40 3D-printed casts were digitized again. All scanned files were compared with the corresponding STL files in a surface-matching software program. The dimensional accuracy was measured and compared by the root mean square (RMS, in μm). Repeated measures analysis of variance (ANOVA) was used to compare RMS values among the variables, and the Tukey honestly significant difference (HSD) test was used for post hoc multiple comparisons (α=.05).The casts produced from the DLP 3D printer had a significantly higher mean ±standard deviation RMS of 153.7 ±25.4 μm than those produced with the MJ 3D printer with RMS of 134.1 ±16.0 μm (P.001). The storage condition (box storage versus light exposure) did not affect the accuracy of the DLP-printed casts (P=.615) or the MJ-printed casts (P=.999). When comparing all 3D-printed casts after 3-month storage, group DLP-3M-Lit had the highest mean ±standard deviation RMS of 163.0 ±26.5 μm, and group MJ-3M-Box had the lowest RMS of 132.8 ±16.9 μm. The DLP-printed casts stored under light exposure were significantly less accurate than the MJ-printed casts stored in the box (P=.048). DLP-printed casts stored under light exposure showed significant surface color change under visual inspection.The MJ 3D printer produced more accurate 3D-printed dental casts than the DLP 3D printer. After 3-month storage, the DLP-printed casts stored under light exposure were the least accurate, and the MJ-printed casts stored without light exposure were the most accurate. The surface color change of DLP-printed casts stored under light exposure after 3-month storage was evident.

Background Marginal fit is critical for the success and longevity of a dental restoration. Zirconia crowns can be fabricated either chair-side, in a dental laboratory or in a milling center; each can give different marginal fits results. However, discussion of the marginal fit of zirconia crowns when different fabrication methods are compared is lacking in the literature. Purpose To compare the marginal discrepancy (MD) and absolute marginal discrepancy (AMD) of computer-aided design, and computer-aided manufacturing (CAD-CAM) used in a dental laboratory and a milling center for producing monolithic zirconia crowns. Methods The marginal fit of 30 zirconia crowns cemented to typodont teeth was evaluated by means of a sectioning technique. Fifteen crowns were fabricated with a CEREC inLAB MC X5 from IPS e.max ZirCAD blocks. Fifteen crowns were fabricated using a LAVA milling center from LAVA Plus Zirconia Blocks. The 30 crowns were sectioned with a precision saw, and MD and AMD were subsequently measured using a light microscope. Data were analyzed using the one-way ANOVA technique to investigate significant differences in the marginal fit between the two fabrication systems (α = .05). Results The AMD dimension of the CEREC inLAB system was significantly smaller (P

The aim of this study was to evaluate teeth prepared for computer-aided design/computer-aided manufacturing (CAD/CAM) restorations by senior dental students using recently developed rubrics. The rubrics used evaluation criteria based on four factors: retention or resistance form; marginal or internal adaption or manufacturing process; biology, esthetics, or durability of restorative material; and intraoral scanner impression. In academic year 2018-19, four faculty members used the rubrics to assess 111 first maxillary right premolars (tooth no. 4) prepared for lithium disilicate crowns and 223 second maxillary right premolars (tooth no. 5) and first maxillary right molars (tooth no. 3) prepared for monolithic zirconia partial fixed dental prostheses. The preparations had been performed on typodont teeth. The most common errors identified for tooth preparations were in the finish line quality (136 errors in 223 prostheses), a criterion that is crucial for quality CAD/CAM restorations. To prevent poorly fit CAD/CAM restoration preparations that result from an unacceptable finish line quality, students need to understand the rationale used to develop detailed rubrics and adhere to the defined critera.

Statement of problem Additive manufacturing (AM) technologies can be used to fabricate definitive casts for implant-supported restorations. However, information regarding the accuracy of the implant replica position on the polymeric AM cast generated with different scan bodies and digital implant replica systems is lacking. Purpose The purpose of this in vitro study was to compare with a conventional stone cast the linear and angular discrepancies of the implant analog positions in a polymeric AM cast obtained from 3 different scan body and digital implant replica systems. Material and methods A partially edentulous maxillary typodont with 3 implant replicas (Implant replica RP Branemark system; Nobel Biocare) was prepared. Two duplicating methods were evaluated: conventional (CNV group) and AM (AM group) procedures. For the CNV group, polyvinyl siloxane open-tray implant impressions (CNV) were made at room temperature (23 °C). The AM group was further divided into the subgroups Elos Medtech, Nt-Trading, and Dynamic Abutment. For the Elos Medtech subgroup, the corresponding scan bodies were placed on each implant, and the typodont was digitized by using a laboratory scanner (E3 scanner; 3Shape A/S). The same procedure was repeated with the remaining subgroups. All the AM polymer casts were fabricated at once by using the same 3D printer (Eden 500V; Stratasys). Ten specimens of each group were obtained (n=10). A coordinate-measuring machine (CMM) was used to measure the position of each implant replica, and distortion was calculated for each system at the x-, y-, and z-axes and 3D distortion measurement ( 3 D = x 2 + y 2 + z 2 ). The Shapiro-Wilk test revealed that the data were not normally distributed. The Kruskal-Wallis and pairwise Mann-Whitney U tests (α=.05) were used for the analysis. Results The CNV group presented significantly higher linear discrepancy than the Dynamic Abutment group on the x- and y-axes. On the z-axis, however, the CNV group showed significantly lower linear discrepancy than the Nt-Trading and Dynamic Abutment groups. The 3D linear discrepancy was 12 ±12 μm for the CNV group, 4 ±100 μm for the Elos Medtech group, 8 ±52 μm for the Nt-Trading group, and 5 ±19 μm for the Dynamic Abutment. The CNV group demonstrated a significantly higher angle than the Nt-Trading group but a significantly smaller angle than the Elos Medtech and Dynamic Abutment groups. Conclusions The AM groups had lower 3D discrepancies than the CNV group. The Dynamic Abutment group had significantly better accuracy for the mesiodistal and buccolingual implant replica positions than the CNV group, but the conventional procedures had significantly better results for the apicocoronal implant replica position. Scan body and digital implant replica design systems only influenced the accuracy of the angular implant replica position on the AM casts.

Statement of problem: Intraoral scanners are promising options for removable prosthodontics. However, analog aids, including occlusion rims, are still used, as a completely digital workflow is challenging and scientific evidence on the topic is scarce. Purpose: The purpose of this in vitro study was to assess and compare the trueness and precision of scans obtained from a reference typodont of a completely edentulous maxilla by using an intraoral scanner (TRIOS 3 Pod; 3Shape A/S) with scans obtained by using a laboratory scanner (DScan 3; EGS S.R.L.) from both Type IV stone casts and polysulfide impressions. Material and methods: The polyurethane resin reference typodont was replicated from a clinical cast and was scanned with a metrological machine to obtain a reference scan. Ten digital casts were obtained by applying standardized scanning strategies to the reference typodont with the intraoral scanner. A device was created to make 10 consistent polysulfide impressions, and a scan of each impression was made with the laboratory scanner and then digitally reversed to obtain 10 digital reversed casts. Ten Type IV stone casts were poured and then scanned with the laboratory scanner to obtain 10 digital extraoral scanner casts. The scans in standard tessellation language (STL) format were imported into a dedicated software program, and the trueness and precision were calculated in μm. In addition to descriptive statistics (confidence interval 95%), 1-way ANOVA followed by the Bonferroni test or the Kruskal-Wallis and the Dunn tests were used to analyze differences among groups (α=.05). Results: The trueness values (95% confidence interval) were digital intraoral scanner cast=48.7 (37.8-59.5), digital reversed cast=249.9 (121.3-378.5), and digital extraoral scanner cast=308.8 (186.6-430.9); significant differences were detected between digital intraoral scanner cast and digital reversed cast (P

Limited evidence is available comparing the differences between pre-operative and post-operative 3D implant positions from the viewpoint of prosthetics. We aimed to investigate the differences between preplanned positions of virtual provisional restorations and their actual positions following fully guided single-implant placement. Ten maxillary typodonts with missing right central incisors were imaged using cone-beam computed tomography, and digital impressions were obtained using an intraoral scanner. These data were imported into implant-planning software, following which the provisional restorations were designed. After data superimposition, an appropriate implant position was determined, and a computer-assisted implant surgical guide was designed for each typodont. Orders generated from the implant-planning software were imported into relevant computer-aided design software to design the custom abutments. The abutments, provisional restorations, and surgical guides were fabricated, and each restoration was cemented to the corresponding abutments, generating a screw-type immediate provisional restoration. The implants were placed using the surgical guides, and the screw-type provisional restorations were engaged to the implants. The typodonts were then rescanned using the intraoral scanner. The restorations designed at the treatment planning stage were compared with those in the post-operative scan using metrology software. The angular deviation around the central axis of the implant was measured, and the differences in the crown position were converted to root mean square (RMS) values. The post-operative provisional restorations exhibited an absolute angular deviation of 6.94 &plusmn, 5.78&deg, and an RMS value of 85.8 &plusmn, 20.2 &micro, m when compared with their positions in the pre-operative stage. Within the limitations of the present in vitro study, the results highlight the potential application of customized prefabricated immediate provisional restorations after single-implant placement.

Although digital scanning has become popular, conventional impressions with polyvinyl siloxane (PVS) are still the gold standard for fabricating indirect restorations. Studies comparing the marginal fit obtained from both techniques are sparse.The purpose of this in vitro study was to compare the marginal fit of zirconia copings fabricated by using a conventional impression and 2 digital scanning techniques.A typodont mandibular left second premolar was prepared for a complete crown. Ten impressions were made in each experimental group: PVS group, conventional impression with PVS; TRIOS 3 group, impression with intraoral scanner TRIOS 3; and CS 3600 group, impression with intraoral scanner CS 3600. Thirty zirconia copings were fabricated with computer-aided design and computer-aided manufacturing (CAD-CAM) technology, and the marginal discrepancy was measured in 4 locations per specimen by using a stereo microscope. Additionally, the marginal discrepancy of each coping obtained in the PVS group was measured on the stone die produced, creating the PVS A group. The mean value of discrepancy was calculated for each location and each group. Statistically significant differences among the impression techniques were tested with 1-way ANOVA, repeated measures ANOVA, and the t test (α=.05).The mean ±standard deviation values of vertical marginal discrepancy were 106 ±87 μm for the PVS group, 34 ±49 μm for the PVS A group, 53 ±56 μm for the TRIOS 3 group, and 93 ±69 μm for the CS 3600 group. Statistically significant differences (P.05) were found between the PVS group and TRIOS 3 group and between the CS 3600 group and TRIOS 3 group.Digital scanning with the TRIOS 3 showed lower values of marginal discrepancy than the digital scan with the CS 3600 and conventional impression making with an elastomer.

In Part I of this study, evidence was presented that visual inspection (VI) of dental student waxups exhibited low precision (ICC=0.332) and accuracy, resulting in questionable grade validity. VI inappropriately assesses morphology in part due to oversimplified grading rubrics and inappropriate application of ratio measurement to ordinal data. The aim of Part II of this study was to develop, apply, and compare with VI a digital assessment workflow and report the outcomes. After inclusion criteria were met, 67 (83%) student waxups were scanned with an intraoral scanner and analyzed using open source surface comparison software. Each was digitally compared to the homologous standard typodont tooth. Percentage contour variation within a stipulated tolerance was computed. The acceptable tolerance was derived from clinical literature reporting how contour deviations impact the biological and biomechanical stability of teeth and periodontium. Surface roughness of each waxup was also computed and compared with the reference teeth. A formula for digital assessment was developed and applied to each waxup. On average, digital grades exceeded the VI assessments, while correcting individual errors for greater accuracy and precision (ICC=0.866). Students were able to easily apply the digital workflow for visualization and accurate self-evaluation. In this study, a digital grading workflow was developed that used portable data formats and freely available open source analysis software, so the method could be introduced at any dental school where intraoral scanning is available.

BACKGROUND The Bologna reform resulted in a drastic restructuring of pre-clinical training courses at the University of Zurich. The aim of this study was to assess student pre-clinical scaling/root planning skills after just 8.5 hours of manual training. MATERIAL AND METHODS Three consecutive classes of dental students (n = 41; n = 34; n = 48) were tasked with removing lacquer concrement from the maxillary left canine on a typodont using Gracey and universal (Deppeler M23A) curettes. At baseline (prior to instruction), a timed five-minute session of scaling/root planning was undertaken. The second scaling/root planning session was held immediately following training. Eight experienced dental hygienists and eight lay people served as positive and negative controls, using the same instruments and time limit, respectively. Instrumented teeth were collected, scanned and planimetrically analysed for the percentage of tooth surface cleaned. Statistical analyses were performed to assess the dental students' improvement after the training (Wilcoxon signed-rank test) and to compare it to that of laypeople and dental hygienists (Kruskal-Wallis rank sum test followed by Conover's post hoc test). RESULTS At baseline, the dental students' mean scaling scores of the cleaned surfaces were not significantly different than those of laypeople (29.8%, 31.0%, 42% vs 27.9%). However, after 8.5 hours of manual training, the students' ability to clean the maxillary tooth improved significantly and they achieved mean removal values of 61.7%, 79.5% and 76% compared to the 67.4% (P

Prefabricated zirconia crowns (ZRCs) require a passive fit and more reduction than stainless steel crowns (SSC). To determine the mean and maximum reduction depths in the mesial-buccal and occlusal areas for three ZRC brands and one SSC in posterior primary typodont molars and to compare reduction depths to existing literature to determine the preparation’s proximity to pulpal tissue. Four primary maxillary and mandibular typodont teeth (J and S) were prepared according to the manufacturers’ guidelines for three ZRCs and an SSC. The teeth were scanned before and after preparation with an optical scanner, and the mean and maximum depths of reduction for each tooth were calculated in triplicate with custom software and statistically compared among the types of crown. The results were compared to existing data on primary tooth enamel and dentin thickness. Maximum mesial-buccal and occlusal depth respectively of preparation for any ZRC for tooth J was 1.19 mm and 1.58 mm while for tooth S it was 1.06 and 2.07mm Both EZ Crowns and Kinder Krowns required an additional 0.5mm occlusal reduction beyond the manufacturer’s recommendation for tooth S. Ideal preparations of ZRCs require more reduction than SSCs. Both EZ Crowns and Kinder Krowns require more reduction than the manufacturer’s recommendation for a mandibular first primary molar.

Background: Dental scanners play a critical role in computer-aided design/computer-aided manufacturing technology. This study aimed to compare the accuracy (precision and trueness) of eight dental scanners for dental bridge scanning. Materials and Methods: In this in-vitro experimental study, a typodont model with a missing maxillary right first molar was prepared for a 3-unit fixed partial denture. Each scanner (Sirona inEos inLab, Sirona X5, Dentium, Imes icore 350I I3D, Amann Girrbach map 100, 3Shape D100, 3Shape E3) performed seven scans of the typodont, and the data were analyzed using 3D-Tool software. The abutment length, abutment width, arch length, and interdental distance were measured. To assess the accuracy of each scanner, trueness was evaluated by superimposing the scanned data on true values obtained by the 3shape Triosscanner as the reference. Precision was evaluated by superimposing a pair of data sets obtained from the same scanner. Precision and trueness of the scanners were compared using the one-way ANOVA followed by the post-hoc Tukey's HSD test and one-sample t-test (P

Monolithic zirconia crowns fabricated with computer-aided design and computer-aided manufacturing (CAD-CAM) have recently become a common practice for the restoration of posterior teeth. The marginal fit of monolithic zirconia crowns may be affected by different cement space parameters set in the CAD software. Information is scarce regarding the effect of cement space on the marginal fit of monolithic zirconia crowns fabricated with CAD-CAM technology.The purpose of this in vitro study was to evaluate the effect of cement space on the marginal fit of CAD-CAM-fabricated monolithic zirconia crowns before cementation.Fifteen right maxillary first molar typodont teeth with standardized anatomic preparations for complete-coverage ceramic crowns were scanned with a 3-dimensional laboratory scanner. Crowns were designed 3-dimensionally using software and then milled from presintered monolithic zirconia blocks in a computer numerical control dental milling machine. The cement space was set at 25 μm around the margins for all groups, and additional cement space starting 1 mm above the finish lines of the teeth was set at 30 μm for group 25-30, 40 μm for group 25-40, and 50 μm for group 25-50 in the CAD software. A total of 120 images (3 groups, 5 crowns per group, 8 sites per crown) were measured for vertical marginal discrepancy under a stereoscopic zoom microscope and the data were statistically analyzed with 1-way analysis of variance, followed by the Tukey honestly significant difference test (α=.05).The results showed that different cement space values had statistically significant effect on the mean vertical marginal discrepancy value of tested crowns (P.001). The mean marginal discrepancy was 85 μm for group 25-30, 68 μm for group 25-40, and 53 μm for group 25-50.Within the limitations of this in vitro study, it was concluded that the cement space had a significant effect on the marginal fit of CAD-CAM-fabricated monolithic zirconia crowns. The marginal fit improved as the cement space decreased.

Statement of problem Although the number of lithium disilicate crowns fabricated with computer-aided design and computer-aided manufacturing (CAD-CAM) technology has increased, the accuracy of the prostheses produced by using digital pathways remains unknown. Purpose The purpose of this in vitro study was to compare marginal and internal discrepancies of lithium disilicate crowns fabricated from digital and conventional impressions. Material and methods A typodont mandibular first molar was prepared for a lithium disilicate crown, and 20 duplicate dies were fabricated by milling poly(methyl methacrylate) resin blocks from laboratory scans. Four groups of 5 lithium disilicate crowns each were created by using a CS3500 (Carestream Dental) intraoral digital impression; Trios (3shape) intraoral digital impression; Ceramill Map400 (Amann Girrbach) extraoral digital impression; and a heat-press technique as a control group. All of the IPS e.max CAD (Ivoclar Vivadent AG) crowns were produced using a 5-axis milling engine (Ceramill Motion2). The lithium disilicate crowns were cemented with zinc phosphate cement under finger pressure. Marginal and internal discrepancies were measured using micro-computed tomography (SkyScan1172). One-way ANOVAs with the Tukey honest significant differences test were used for statistical analysis of the data (α=.05). Results The mean marginal discrepancies of CS3500 lithium disilicate crowns were 129.6 μm, 200.9 μm for Ceramill Map400, and 207.8 μm 176.1 μm for the heat-press technique; and the internal discrepancy volumes for CS3500 were 25.3 mm 3 , 40.7 mm 3 for Trios, 29.1 mm 3 for Ceramill Map400, and 29.1 and 31.4 mm 3 for the heat-press technique. The CS3500 group showed a significantly better marginal discrepancy than the other 3 groups and a smaller internal discrepancy volume than the Trios group ( P Conclusions Significant differences were found between IPS e.max CAD crowns produced using 2 intraoral digital impressions, whereas no differences were found between IPS e.max CAD crowns produced from an extraoral digital impression and IPS e.max Press crowns produced using a heat-press technique.

Purpose To investigate the effect of core/veneer thickness ratio on the fracture strength of lithium disilicate crowns subjected to cyclic loading in a simulated oral environment. Materials and Methods A typodont molar tooth received a standard complete crown preparation according to the manufacturer's instructions. Sixty lithium disilicate crowns were prepared and assigned to three groups with the following core/veneer thickness ratios A: 0.7 (0.6/0.9), B: 1.1 (0.8/0.7), and C: 2 (1.0/0.5). The cores were milled from lithium disilicate e.max CAD blocks and hand-layered using e.max Ceram. Ten specimens from each group acted as control, while the remaining ten specimens were subjected to thermal mechanical loading in a chewing simulator. All specimens were then subjected to the single load to fracture test at 1 mm/min crosshead speed. Data were analyzed using two-way ANOVA, Tukey multiple comparison test, Pearson correlation test, and quadratic regression (p < 0.05). Results All crowns survived fatigue testing with no signs of fractures or chipping, resulting in a 100% survival rate. The mean fracture load values for control and corresponding fatigued specimens (N) were 1075 and 987 for group A, 1548 and 1482 for group B, and 1455 and 1163 for group C. Increasing the core/veneer thickness ratio from 0.7 to 1.1 significantly increased the fracture load of the crowns; however, a further increase in the ratio up to 2 did not affect the fracture load compared to the 1.1 ratio (p > 0.05). The increase in core thickness significantly positively correlated with the fracture force for control specimens (r = 0.76; p < 0.05). After single load to fracture, crowns predominantly failed by bulk fracture, including the whole thickness of the crowns. Fracture modes were categorized according to fracture path and number of fractured pieces. Conclusions Crowns with a 1.1 (0.8/0.7) core/veneer thickness ratio showed the optimum fracture load among control and fatigued groups. Reducing the core thickness from 0.8 mm to 0.6 mm decreased the fracture load significantly, while increasing it to 1.0 mm showed no statistical effect. Cyclic loading in a simulated oral environment did not significantly affect fracture strength of veneered lithium disilicate crowns in any of the tested groups.

Objective: We evaluated the effects of tooth displacement on frictional force when conventional ligating lingual brackets (CL-LBs), CL-LBs with a narrow bracket width, and self-ligating lingual brackets (SL-LBs) were used with initial leveling and alignment wires. Methods: CL-LBs (7th Generation), CLLBs with a narrow bracket width (STb), and SL-LBs (In-Ovation L) were tested under three tooth displacement conditions: no displacement (control); a 2-mm palatal displacement (PD) of the maxillary right lateral incisor (MXLI); and a 2-mm gingival displacement (GD) of the maxillary right canine (MXC) (nine groups, n = 7 per group). A stereolithographic typodont system and artificial saliva were used. Static and kinetic frictional forces (SFF and KFF, respectively) were measured while drawing a 0.013-inch copper-nickel-titanium archwire through brackets at 0.5 mm/min for 5 minutes at 36.5 o C. Results: The In-Ovation L exhibited lower SFF under control conditions and lower KFF under all displacement conditions than the 7th Generation and STb (all p < 0.001). No significant difference in SFF existed between the In-Ovation L and STb for a 2-mm GD of the MXC and 2-mm PD of the MXLI. A 2-mm GD of the MXC produced higher SFF and KFF than a 2-mm PD of the MXLI in all brackets (all p < 0.001). Conclusions: CLLBs with narrow bracket widths exhibited higher KFF than SL-LBs under tooth displacement conditions. CL-LBs and ligation methods should be developed to produce SFF and KFF as low as those in SL-LBs during the initial and leveling stage. [Korean J Orthod 2016;46(2):87-95]

To assess the reliability of inter-radicular measurements taken using dental pantomograms (DPT), long cone periapical radiographs (LCPA) and cone bean computed tomography (CBCT).A typodont simulating a hypodontia patient undergoing fixed appliance treatment was used. LCPAs, DPT, I-CAT and Accuitomo CBCT images were taken and the distances between the edentulous spans were measured at the midpoint of the roots and the cemento-enamel junctions (CEJ) of adjacent teeth. The results of each modality were compared to each other to the actual inter-radicular space.The DPT overestimated inter-radicular widths by 2 mm or more [mean: 2.48; 95% confidence interval (CI): -1.09 to 6.05 mm]. The LCPA overestimated the inter-radicular widths by 1.5 mm with a 95% CI of -0.095 to 4.03 mm. The mean differences between gold standard (model) and Accuitomo was 0.57 mm (95% CI: -0.37 to 1.51 mm) for the root mean and 0.22 mm (95% CI: -0.52 to 0.96 mm) for the CEJ. This was similar to the differences between the model and I-CAT where the inter-radicular root mean difference was 0.38 mm (95% CI: -0.38 to 1.14 mm) and the CEJ mean difference was 0.21 mm (95% CI: -0.50 to 0.92 mm).The CBCT overestimated the root distance by 0.48 mm and the CEJ width by 0.22 mm, which is clinically irrelevant for implant placement. The DPT overestimated inter-radicular width by 2 mm and the LCPA by 1.5 mm and this difference may put roots of adjacent teeth at risk during implant placement.

Statement of problem: Information about the accuracy of intraoral scanners for the edentulous maxilla is lacking. Purpose: The purpose of this in vitro study was to compare the accuracy of 3 different intraoral scanner techniques on a completely edentulous maxilla typodont. Material and methods: Two completely edentulous maxillary typodonts with (wrinkled typodont) and without (smooth typodont) palatal rugae were used as reference and were scanned by using an industrial metrological machine to obtain 2 digital reference scans in standard tessellation language (STL) format (dWT and dST). Three different scanning techniques were investigated: in the buccopalatal technique, the buccal vestibule was scanned with a longitudinal movement ending on the palatal vault with a posteroanterior direction; the S-shaped technique was based on an alternate palatobuccal and buccopalatal scan along the ridge; in the palatobuccal technique, the palate was scanned with a circular movement and then with a longitudinal one along the buccal vestibule. Consecutively, 6 types of scans were obtained (n=10), namely wrinkled typodont/buccopalatal technique, wrinkled typodont/S-shaped technique, wrinkled typodont/palatobuccal technique (wrinkled typodont), smooth typodont/buccopalatal technique, smooth typodont/S-shaped technique, and smooth typodont/palatobuccal technique (smooth typodont). Scans in STL format were imported into a dedicated software program, and trueness and precision were evaluated in μm. In addition to descriptive statistics (95% confidence interval), a 2-factor ANOVA on the data ranks, the Kruskal-Wallis, and the Dunn tests were performed to analyze differences among groups (α=.05). Results: Mean values for trueness (95% confidence interval) were wrinkled typodont/buccopalatal technique=48.7 (37.8-59.5); wrinkled typodont/S-shaped technique=65.9 (54.9-77.4); wrinkled typodont/palatobuccal technique=109.7 (96.1-123.4); smooth typodont/buccopalatal technique=48.1 (42.4-53.7); smooth typodont/S-shaped technique=56.4 (43.9-68.9); smooth typodont/palatobuccal technique=61.1 (53.3-69), with statistically significant differences for wrinkled typodont/buccopalatal technique versus wrinkled typodont/palatobuccal technique (P

To assess the accuracy of various intraoral scanners (IOSs) and to investigate the existence of mutual compatibility that affects the accuracy between IOS and 3-dimensional (3D) printing using a scan quadrant model. For clinical implication, crown preparations and cavity design according to prosthetic diagnosis and treatment considerations must be acquired by a digital scanner. The selected typodont model was scanned using a reference scanner, from which reference (Ref) standard tessellation language (STL) data were created. Data obtained by scanning the typodont model with IOSs based on three different technologies were divided into three groups (CS3600, i500, and Trios3). Scanned data from the groups were divided into sub-groups of digital light processing (DLP), fused deposition modeling (FDM), and stereolithography apparatus (SLA), based on which 3D printed models (3DP) were fabricated. The 3DP dental models were scanned to obtain a total of 90 3DP STL datasets. The best-fit algorithm of 3D analysis software was used for teeth and arch measurements, while trueness was analyzed by calculating the average deviation among measured values based on superimposition of Ref and IOS and 3DP data. The differences between Ref and IOS (Ref-IOS), Ref and 3DP (Ref-IOS/3DP), and IOS and 3DP data (IOS-3DP) were compared and analyzed, while accuracy within each of the three main groups was assessed. For statistical analysis, the Kruskal&ndash, Wallis, Mann&ndash, Whitney U, and repeated measures ANOVA test were used (p &lt, 0.05). The major finding is that the mutual relationships between IOSs and 3D printers vary depending on the combination. However, i500 intraoral scanner and DLP 3D printer was the combination that showed the best trueness value.

Objective\ud \ud To compare the fatigue strength of lithium disilicate ceramic crowns when cemented as a compound structure, as a function of the manufacturing process and the type of ceramic variation.\ud \ud \ud \ud Method\ud \ud A typodont maxillary first premolar was prepared for an all-ceramic crown in accordance with the manufacturer's guidelines for monolithic ceramic crowns (IPS e. max®; Ivoclar-Vivadent, Liechtenstein). 60 dies were duplicated in a polymer with a Young's Modulus closely matched to dentine (Alpha die, Schütz GmbH). Three different crown fabrication techniques were used (n = 20): (i) Manually applied wax spacer and pressed-crown; (ii) digitally scanned preparation, CAD-printed wax-pattern (D76PLUS, Solidscape Inc.) and pressed-crown; (iii) digitally scanned preparation and machined-crown (CEREC-inLab® v3.6 Sirona GmbH). Resin-based cement (Variolink-II®, Ivoclar-Vivadent, Liechtenstein) was employed with a standardised mechanised cementation technique to apply a controlled axial cementation pressure [Universal testing machine (Lloyd LRX®, Lloyd Materials Testing Inc)]. The samples were subjected to fatigue life testing with a cyclic impact load of 453 N for 1.25 × 106cycles at 37C⁰ and 1 Hz frequency until the point of fracture.\ud \ud \ud \ud Result\ud \ud There was a significant difference in the resistance to fatigue loading between the three groups. Weibull probability analysis and the α and β Weibull parameters indicate that the teeth restored with a ‘Manually-applied wax spacer and pressed-crown’ are best able to resist cyclic fatigue loading. They also have the most uniform interface geometry.\ud \ud \ud \ud Conclusion\ud \ud Teeth restored with IPS e. max® crowns constructed by manually applied wax spacer and pressing, have a more uniform interface and a greater structural integrity than wax CAD-printed patterns or CAD-CAM crowns.

The advancement of intraoral scanners has allowed for more efficient workflow in the dental clinical setting. However, limited data exist regarding the accuracy of the digital impressions produced with various scanner settings and scanning approaches. The purpose of this in vitro study was to compare the accuracy of digital impressions at the crown preparation margin using different scanning resolutions of a specific intraoral scanner system. An all-ceramic crown preparation of a mandibular first molar was constructed in a typodont, and a scan (n = 3) was created with an industrial-grade laboratory scanner (3Shape D2000) as the control. Digital impressions were obtained with an intraoral scanner (3Shape TRIOS 3) under three settings&mdash, high resolution (HR), standard resolution (SR), and combined resolution (SHR). Comparative 3D analysis of scans was performed with Geomagic Control X software to measure the discrepancy between intraoral scans and the control scan along the preparation finish line. The scan time and number of images captured per scan were recorded. Statistical analysis was performed by one-way ANOVA, two-way repeated measures ANOVA, Pearson&rsquo, s correlation, and Dunnett&rsquo, s T3 test (&alpha, = 0.05). Significant differences were observed for scan time and for number of images captured among scan resolution settings (&alpha, &lt, 0.05). The scan time for the SR group was, on average, 34.2 s less than the SHR group and 46.5 s less than the HR group. For discrepancy on the finish line, no significant differences were observed among scanning resolutions (HR: 31.5 &plusmn, 5.5 &mu, m, SHR: 33.2 &plusmn, 3.7 &mu, m, SR: 33.6 &plusmn, 3.1 &mu, m). Significant differences in discrepancy were observed among tooth surfaces, with the distal surface showing the highest discrepancies. In conclusion, the resolution of the intra-oral scanner is primarily defined by the system hardware and optimized for default scans. A software high-resolution mode that obtains more data over a longer time may not necessarily benefit the scan accuracy, while the tooth preparation and surface parameters do affect the accuracy.

Objective The Heat Induction Typodont System (HITS), used in some recent studies, has a distinct advantage over previous tooth movement simulation methods. This study aimed to compare inclination and vertical changes between the single-wire and double-wire techniques during en masse retraction with different lengths of lever arms in lingual orthodontics using an upgraded version of the HITS. Methods Duet lingual brackets, which have two main slots, were used in this study. Forty samples were divided into four groups according to the length of the lever arm (3-mm or 6-mm hook) and the retraction wire (single-wire or double-wire). Four millimeters of en masse retraction was performed using lingual appliances. Thereafter, 3-dimensional-scanned images of the typodont were analyzed to measure inclination and vertical changes of the anterior teeth. Results Incisor inclination presented more changes in the single-wire groups than in the double-wire groups. However, canine inclination did not differ between these groups. Regarding vertical changes, only the lateral incisors in the single-wire groups presented significantly larger values than did those in the double-wire groups. Combining the effect of hook lengths, among the four groups, the single-wire group with the 3-mm hook had the highest value, while the double-wire group with the 6-mm hook showed the least decrease in crown inclination and extrusion. Conclusions The double-wire technique with an extended lever arm provided advantages over the single-wire technique with the same lever arm length in preventing torque loss and extrusion of the anterior teeth during en masse retraction in lingual orthodontics.

The aim of this study was to assess inter-and intra-grader agreement with the use of digital scanning and a tooth preparation assessment software program in comparison to the current traditional visual grading method in a dental student simulation laboratory. Students' typodont teeth preparations from previous practical examinations were used (cast crown n=50; cast fixed partial denture abutments n=50). Five preclinical instructors received calibration training and evaluated each of the preparations by the traditional visual grading method using a rubric. The same preparations were assessed by the same instructors using a tooth preparation assessment software program (PrepCheck, Sirona). The results showed that intra-grader agreement was significantly higher when grades were determined by PrepCheck compared to the traditional visual grading method. The traditional method was associated with significantly greater inter-grader disagreement in comparison to grading using PrepCheck (p

AIM The aim of the present study was to evaluate the marginal and internal fit of zirconium fixed partial denture using different impression techniques. METHODS A Nissin Typodont model, including maxillary central incisor and canine with missing lateral incisor, was selected for the present study. Thirty zirconium frameworks were fabricated following three impression techniques (N = 10), conventional silicone impression (group C), scanned dental impression (group S), and Trios 3 (3Shape) intraoral scanner (group T). An extra-fine milling strategy was applied. RESULTS Group T had the smallest discrepancy compared to groups C (P = 0.006) and S (P = 0.052) at the marginal level, whereas it was larger at the incisal tip. Discrepancies in group T were smaller than group C (P = 0.004) when measured at the axial walls, and smaller than group S (P = 0.045) when measured at the chamfer area for the central teeth only. Samples in group T showed a greater percentage of equally extended restorations (52.5%), while other groups were mainly underextended (group C: 63.7%, group S: 68.8%). CONCLUSION Better adaptation was achieved with the intraoral scanner group, except at the incisal tip. Conventional and scanned impressions revealed a greater percentage of underextended restorations.