Moritz Zimmermann

Intraoral scanning systems - a current overview.

There is no doubt today about the possibilities and potential of digital impression-taking with the aid of intraoral optical impression systems, and the past few years have seen a considerable increase in the range of optical intraoral scanners available on the market. On the strength of numerous innovations and a wider range of indications in orthodontics and implantology, intraoral scanning systems appear to be a highly promising development for the future. Digital impression-taking with intraoral scanners has already shown itself in some respects to be clearly superior to conventional impression- taking. Particularly worthy of mention is the versatile integration of digital impressions into diagnostic and treatment concepts to provide a customizable healthcare solution for the patient. It remains exciting to look forward to future developments that will allow us to observe digital impression-taking--as with other digital applications already established in everyday life--becoming firmly established in the routine of dentistry and dental technology. This article presents an overview of the benefits and limitations of digital impression-taking using intraoral scanning systems, and includes a summary of all the relevant intraoral scanners available on the market at present.

Clinical evaluation of indirect particle-filled composite resin CAD/CAM partial crowns after 24 months

PURPOSE Resin-based CAD/CAM compound materials might be promising for single-tooth restorations. Insufficient clinical data are available for this new material class. The purpose of this study was to describe initial clinical in vivo results for indirect particle-filled composite resin CAD/CAM restorations after 24 months. MATERIALS AND METHODS Indirect particle-filled composite resin restorations were fabricated with a CAD/CAM method (CEREC Bluecam intraoral scanner, CEREC MCXL milling unit) by calibrated dental students. Forty-two partial crown restorations were seated adhesively in 30 patients with caries lesions or insufficient restorations (baseline). Strict inclusion criteria were defined for the patient collective. Follow-up evaluation comprised 40 restorations after 12 months and 33 restorations after 24 months. Evaluation criteria were modified FDI criteria with grades (1) to (5). Rating with FDI criteria (5) was defined as clinical failure. Statistical analysis was performed with Wilcoxon-Test (p < 0.05). RESULTS The success rate of indirect particle-filled composite resin CAD/CAM restorations after 12 months was 95.0% with two debondings observed. The cumulative success rate for indirect particle-filled composite resin CAD/CAM restorations after 24 months was 85.7% with two tooth fractures and one debonding. Statistically significant differences were found for baseline and 24-month follow-up evaluation for anatomic form and marginal adaptation criterion examined in respect to FDI criteria guidelines (Wilcoxon-Test, p < 0.05). CONCLUSIONS This study demonstrates particle-filled composite resin CAD/CAM restorations having a clinical success rate of 85.7% after 24 months. Adhesive bonding procedures need to be ensured carefully. A longer clinical evaluation period is necessary to draw further conclusions.

Chairside treatment of amelogenesis imperfecta, including establishment of a new vertical dimension with resin nanoceramic and intraoral scanning

Amelogenesis imperfecta is a hereditary disease affecting the structural development of tooth substance. This clinical report describes a 1-visit chairside treatment of an 8-year-old patient with amelogenesis imperfecta, using computer-aided design and computer-aided manufacturing (CAD-CAM) technology. Intraoral scanning was performed using the Cerec Omnicam. Thirteen resin nanoceramic crowns (Lava Ultimate) were fabricated chairside by using a Cerec MCXL milling unit and seated adhesively. The patients treatment included establishing a new occlusal vertical dimension and new centric relationship. Reevaluation after 6 months showed a stable situation.

Influence of material thickness on fractural strength of CAD/CAM fabricated ceramic crowns

The fracture behavior of CAD/CAM fabricated crowns was investigated as a function of material thickness for six silicate ceramic materials: Mark II, e.max CAD, Celtra Duo milled, Celtra Duo fired, Suprinity, Enamic. Crowns with thicknesses 0.5/1.0/1.5 mm were fabricated with CEREC and adhesively seated to dies fabricated with stereolithography technology (n=144). Thermomechanical loading and fractural loading was performed. Statistical analysis was done with one-way ANOVA and post-hoc Scheffé test. For 1.5 mm, all crowns survived fatigue testing, for 1.0 mm, survival was 100% only for materials e.max CAD and Suprinity. For 0.5 mm, best survival rate was 37.5% for Suprinity. Maximum fractural loading significantly varied among the groups. For 0.5 mm, highest value was found for Suprinity (660.1 N). Mark II showed lowest values for 1.0 mm (482.0 N), and 1.5 mm groups (634.8 N). e.max CAD showed highest values for 1.0 mm (774.2 N), and 1.5 mm groups (1,240.8 N).

Three-Dimensional Digital Evaluation of the Fit of Endocrowns Fabricated from Different CAD/CAM Materials: Fitchecker CAD/CAM Materials

PURPOSE A wide variety of CAD/CAM materials are available for single-tooth restorations. CAD/CAM material characteristics are different and may influence CAM fabrication accuracy. There is no study investigating the influence of different CAD/CAM materials on the final fit of the restoration. The aim of this study was to evaluate the fit of endocrowns fabricated from different CAD/CAM materials using a new 3D evaluation method with an intraoral scanning system. The null hypothesis was that there are no significant differences for the fitting accuracy of different CAD/CAM materials. MATERIALS AND METHODS Preparation for an endocrown was performed on a maxillary right first molar on a typodont, and restorations were fabricated with a chairside CAD/CAM system (CEREC Omnicam, MCXL). Three groups using three different CAD/CAM materials were established (each n = 10): zirconia-reinforced lithium silicate ceramic (Celtra Duo; CD), leucite-reinforced silicate ceramic (Empress CAD; EM), resin nanoceramic (Lava Ultimate; LU). A 3D digital measurement technique (OraCheck, Cyfex AG) using an intraoral scanner (CEREC Omnicam) was used to measure the difference in fit between the three materials for a master endocrown preparation. The preparation scan and the endocrown fit scan were matched with special difference analysis software OraCheck. Three areas were selected for fitting accuracy measurements: margin (MA), axial (AX), occlusal (OC). Statistical analysis was performed using 80% percentile, one-way ANOVA, and post-hoc Scheffé test. Significance level was set to p = 0.05. RESULTS Results varied from best 88.9 ± 7.7 μm for marginal fit of resin nanoceramic restorations (LU_MA) to worst 182.3 ± 24.0 μm for occlusal fit of zirconia-reinforced lithium silicate restorations (CD_OC). Statistically significant differences were found both within and among the test groups. Group CD performed statistically significantly different from group LU for marginal fit (MA) and axial fit (AX) (p < 0.05). For occlusal fit (OC), no statistically significant differences were found within all three test groups (p > 0.05). Deviation pattern for differences was visually analyzed with a color-coded scheme for each restoration. CONCLUSIONS Statistically significant differences were found for different CAD/CAM materials if the CAM procedure was identical. Within the limitations of this study, the choice of CAD/CAM material may influence the fitting accuracy of CAD/CAM-fabricated restorations.

Digital evaluation of the fit of zirconia-reinforced lithium silicate crowns with a new three-dimensional approach

OBJECTIVE Several methods for the evaluation of fit of computer-aided design/computer-assisted manufacture (CAD/CAM)-fabricated restorations have been described. In the study, digital models were recorded with an intraoral scanning device and were measured using a new three-dimensional (3D) computer technique to evaluate restoration internal fit. The aim of the study was to evaluate the internal adaptation and fit of chairside CAD/CAM-fabricated zirconia-reinforced lithium silicate ceramic crowns fabricated with different post-milling protocols. The null hypothesis was that different post-milling protocols did not influence the fitting accuracy of zirconia-reinforced lithium silicate restorations. METHOD AND MATERIALS A master all-ceramic crown preparation was completed on a maxillary right first molar on a typodont. Twenty zirconia-reinforced lithium silicate ceramic crowns (Celtra Duo, Dentsply Sirona) were designed and milled using a chairside CAD/CAM system (CEREC Omnicam, Dentsply Sirona). The 20 crowns were randomly divided into two groups based on post-milling protocols: no manipulation after milling (Group MI) and oven fired-glazing after milling (Group FG). A 3D computer method was used to evaluate the internal adaptation of the crowns. This was based on a subtractive analysis of a digital scan of the crown preparation and a digital scan of the thickness of the cement space over the crown preparation as recorded by a polyvinylsiloxane (PVS) impression material. The preparation scan and PVS scan were matched in 3D and a 3D difference analysis was performed with a software program (OraCheck, Cyfex). Three areas of internal adaptation and fit were selected for analysis: margin (MA), axial wall (AX), and occlusal surface (OC). Statistical analysis was performed using 80% percentile and one-way ANOVA with post-hoc Scheffé test (P = .05). RESULTS The closest internal adaptation of the crowns was measured at the axial wall with 102.0 ± 11.7 µm for group MI-AX and 106.3 ± 29.3 µm for group FG-AX. The largest internal adaptation of the crowns was measured for the occlusal surface with 258.9 ± 39.2 µm for group MI-OC and 260.6 ± 55.0 µm for group FG-OC. No statistically significant differences were found for the post-milling protocols (P > .05). The 3D difference pattern was visually analyzed for each area with a color-coded scheme. CONCLUSION Post-milling processing did not affect the internal adaptation of zirconia-reinforced lithium silicate crowns fabricated with a chairside CAD/CAM technique. The new 3D computer technique for the evaluation of fit of restorations may be highly promising and has the opportunity to be applied to clinical studies.

CAD/CAM-Restaurationen aus hochgefülltem Komposit: erste klinische Ergebnisse nach 12 Monaten

Einfuhrung: Indirekte Restaurationen, die mit der CAD/CAM-Technologie hergestellt wurden, weisen eine hohe klinische Erfolgsrate auf. Diese Studie untersucht das klinische Verhalten von indirekten Lava Ultimate-Restaurationen nach 12Monaten in Form einer einarmigen Kohortenstudie. Methode: Die Restaurationen wurden mit dem indirekten CEREC-Verfahren (ACBluecam, MCXL) hergestellt. 60 indirekte Restaurationen wurden adhasiv befestigt (Syntac, Variolink II). Nach 12Monaten konnten 55 indirekte Restaurationen ausgewertet werden (22Teilkronen, 18Endocrowns, 6Inlays, 7Kronen). Als Bewertungskriterien wurden modifizierte FDI-Kriterien angewandt. Die statistische Analyse zwischen Baseline- und Follow-up-Kriterien wurde mit dem Wilcoxon-Test (p0,05) durchgefuhrt. Ergebnisse und Schlussfolgerung: Die Erfolgsrate der indirekten Lava Ultimate-Restaurationen nach 12Monaten betrug 96,4%. Zwei Restaurationen scheiterten klinisch in Folge von Debonding (Ausfallrate 3,6%). Diese Studie zeigt, dass indirekte Restaurationen aus Lava Ultimate eine hohe klinische Erfolgsrate aufweisen. Ein langerer klinischer Bewertungszeitraum scheint notwendig, um weitere Schlussfolgerungen zu ziehen.