Walter G. Renne

Predicting marginal fit of CAD/CAM crowns based on the presence or absence of common preparation errors

STATEMENT OF PROBLEM Confusion exists as to what constitutes an ideal ceramic crown preparation and whether certain deviations from the ideal can affect the marginal fit of the milled restoration. PURPOSE This study evaluated the marginal gap of E4D crowns fabricated on preparations completed by clinicians with varying levels of expertise to identify whether common errors affect marginal fit. MATERIAL AND METHODS The fit of 75 crowns fabricated with the E4D system on preparations of varying quality were examined for marginal fit by using the replica technique. These same preparations were then visually examined for common criteria for ceramic restorations and placed in one of 3 categories: excellent, fair, or poor. These visual examinations sought the presence of common preparation errors, particularly those involving the finish line. The average marginal gap values and standard deviations were calculated for each category, and the Kruskal-Wallis test was used to determine significance. RESULTS The results showed a statistically significant correlation between the marginal fit of a CAD/CAM fabricated crown and the quality of the preparation. The mean marginal gap of the crowns fabricated on ideal preparations was 38.5 µm, those considered fair had a mean marginal gap of 58.3 µm, while those categorized as poor averaged 90.1 µm. The fit differences among all 3 groups were statistically significant (P<.05). CONCLUSIONS Within the limitations of this in vitro study, it can be concluded that preparation quality has a significant impact on marginal gap on crowns fabricated with a CAD/CAM system.

Evaluation of the accuracy of 7 digital scanners: An in vitro analysis based on 3-dimensional comparisons

Statement of problem. As digital impressions become more common and more digital impression systems are released onto the market, it is essential to systematically and objectively evaluate their accuracy. Purpose. The purpose of this in vitro study was to evaluate and compare the trueness and precision of 6 intraoral scanners and 1 laboratory scanner in both sextant and complete‐arch scenarios. Furthermore, time of scanning was evaluated and correlated with trueness and precision. Material and methods. A custom complete‐arch model was fabricated with a refractive index similar to that of tooth structure. Seven digital impression systems were used to scan the custom model for both posterior sextant and complete arch scenarios. Analysis was performed using 3‐dimensional metrology software to measure discrepancies between the master model and experimental casts. Results. Of the intraoral scanners, the Planscan was found to have the best trueness and precision while the 3Shape Trios was found to have the poorest for sextant scanning (P<.001). The order of trueness for complete arch scanning was as follows: 3Shape D800 >iTero >3Shape TRIOS 3 >Carestream 3500 >Planscan >CEREC Omnicam >CEREC Bluecam. The order of precision for complete‐arch scanning was as follows: CS3500 >iTero >3Shape D800 >3Shape TRIOS 3 >CEREC Omnicam >Planscan >CEREC Bluecam. For the secondary outcome evaluating the effect time has on trueness and precision, the complete‐ arch scan time was highly correlated with both trueness (r=0.771) and precision (r=0.771). Conclusions. For sextant scanning, the Planscan was found to be the most precise and true scanner. For complete‐arch scanning, the 3Shape Trios was found to have the best balance of speed and accuracy.

Evaluation of the Marginal Fit of CAD/CAM Crowns Fabricated Using Two Different Chairside CAD/CAM Systems on Preparations of Varying Quality.

PURPOSE This study evaluated the marginal gap of crowns fabricated using two new chairside computer-aided design/computer-aided manufacturing systems on preparations completed by clinicians with varying levels of expertise to identify whether common preparation errors affect marginal fit. The null hypothesis is that there is no difference in the mean marginal gaps of restorations of varying qualities and no difference in the mean marginal gap size between restorations fabricated using the PlanScan (D4D, Richardson, TX, USA) and the CEREC Omnicam (Sirona, Bensheim, Germany). MATERIAL AND METHODS The fit of 80 lithium disilicate crowns fabricated with the E4D PlanScan or CEREC Omnicam systems on preparations of varying quality were examined for marginal fit by using the replica technique. These same preparations were then visually examined against common criteria for anterior all-ceramic restorations and placed in one of four categories: excellent, good, fair, and poor. Linear mixed modeling was used to evaluate associations between marginal gap, tooth preparation rating, and fabrication machine. RESULTS The fit was not significantly different between both systems across all qualities of preparation. The average fit was 104 μm for poor-quality preparations, 87.6 μm for fair preparations, 67.2 μm for good preparations, and 36.6 μm for excellent preparations. CONCLUSION The null hypothesis is rejected. It can be concluded that preparation quality has a significant impact on marginal gap regardless of which system is used. However, no significant difference was found when comparing the systems to each other. CLINICAL SIGNIFICANCE Within the limitations of this in vitro study, it can be concluded that crown preparation quality has a significant effect on marginal gap of the restoration when the clinician uses either CEREC Omnicam or E4D PlansScan.

Evaluation of the effect scan pattern has on the trueness and precision of six intraoral digital impression systems

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.

Anatomic Customization of Root-Analog Dental Implants With Cone-Beam CT and CAD/CAM Fabrication: A Cadaver-Based Pilot Evaluation

Existing root-analog dental implant systems have no standardized protocols regarding retentive design, surface manipulation, or prosthetic attachment design relative to the sites unique anatomy. Historically, existing systems made those design choices arbitrarily. For this report, strategies were developed that deliberately reference the adjacent anatomy, implant and restorable path of draw, and bone density for implant and retentive design. For proof of concept, dentate arches from human cadavers were scanned using cone-beam computed tomography and then digitally modeled. Teeth of interest were virtually extracted and manipulated via computer-aided design to generate root-analog implants from zirconium. We created a stepwise protocol for analyzing and developing the implant sites, implant design and retention, and prosthetic emergence and connection all from the pre-op cone-beam data. Root-analog implants were placed at the time of extraction and examined radiographically and mechanically concerning ideal fit and stability. This study provides proof of concept that retentive root-analog implants can be produced from cone-beam data while improving fit, retention, safety, esthetics, and restorability when compared to the existing protocols. These advancements may provide the critical steps necessary for clinical relevance and success of immediately placed root-analog implants. Additional studies are necessary to validate the model prior to clinical trial.

A novel technique for reference point generation to aid in intraoral scan alignment

OBJECTIVE When using a completely digital workflow on larger prosthetic cases it is often difficult to communicate to the laboratory or chairside Computer Aided Design and Computer Aided Manufacturing system the provisional prosthetic information. The problem arises when common hard tissue data points are limited or non-existent such as in complete arch cases in which the 3D model of the complete arch provisional restorations must be aligned perfectly with the 3D model of the complete arch preparations. In these instances, soft tissue is not enough to ensure an accurate automatic or manual alignment due to a lack of well-defined reference points. A new technique is proposed for the proper digital alignment of the 3D virtual model of the provisional prosthetic to the 3D virtual model of the prepared teeth in cases where common and coincident hard tissue data points are limited. Clinical considerations: A technique is described in which fiducial composite resin dots are temporarily placed on the intraoral keratinized tissue in strategic locations prior to final impressions. These fiducial dots provide coincident and clear 3D data points that when scanned into a digital impression allow superimposition of the 3D models. CONCLUSIONS Composite resin dots on keratinized tissue were successful at allowing accurate merging of provisional restoration and post-preparation 3D models for the purpose of using the provisional restorations as a guide for final CLINICAL SIGNIFICANCE: Composite resin dots placed temporarily on attached tissue were successful at allowing accurate merging of the provisional restoration 3D models to the preparation 3D models for the purposes of using the provisional restorations as a guide for final restoration design and manufacturing. In this case, they allowed precise superimposition of the 3D models made in the absence of any other hard tissue reference points, resulting in the fabrication of ideal final restorations.

Biocompatibility and bond degradation of poly-acrylic acid coated copper iodide-adhesives

OBJECTIVE To investigate the effect of poly-acrylic acid (PAA) copper iodide (CuI) adhesives on bond degradation, tensile strength, and biocompatibility. METHODS PAA-CuI particles were incorporated into Optibond XTR, Optibond Solo and XP Bond in 0.1 and 0.5mg/ml. Clearfil SE Protect, an MDPB-containing adhesive, was used as control. The adhesives were applied to human dentin, polymerized and restored with composite in 2mm-increments. Resin-dentin beams (0.9±0.1mm2) were evaluated for micro-tensile bond strength after 24h, 6 months and 1year. Hourglass specimens (10×2×1mm) were evaluated for ultimate tensile strength (UTS). Cell metabolic function of human gingival fibroblast cells exposed to adhesive discs (8×1mm) was assessed with MTT assay. Copper release from adhesive discs (5×1mm) was evaluated with UV-vis spectrophotometer after immersion in 0.9% NaCl for 1, 3, 5, 7, 10, 14, 21 and 30 days. SEM, EDX and XRF were conducted for microstructure characterization. RESULTS XTR and Solo did not show degradation when modified with PAA-CuI regardless of the concentration. The UTS for adhesives containing PAA-CuI remained unaltered relative to the controls. The percent viable cells were reduced for Solo 0.5mg/ml and XP 0.1 or 0.5mg/ml PAA-CuI. XP demonstrated the highest ion release. For all groups, the highest release was observed at days 1 and 14. SIGNIFICANCE PAA-CuI particles prevented the bond degradation of XTR and Solo after 1year without an effect on the UTS for any adhesive. Cell viability was affected for some adhesives. A similar pattern of copper release was demonstrated for all adhesives.

Digital Workflow in Implant Dentistry

Purpose of ReviewImplant dentistry is going through a digital revolution. Through the development of new equipment and their corresponding workflows, the diagnosis and treatment of our patients are becoming simpler and more efficient. This review examines the workflows and techniques that apply digital technology to the pre-operative planning stages, the surgical placement, and the prosthetic phases of implant treatment.Recent FindingsWith the current influx of new hardware and software into the market, dental technology has the potential to infiltrate every area of clinical implant dentistry. Its use generally begins with the diagnostic scanning by means of an intra-oral scanner and cone beam computed tomography. These modalities, in conjunction with implant planning software, allow for the planning and the guided surgical execution of dental implants. Technology can further be used with the prosthetic design and manufacturing of the interim and final restorations of the implants allowing all areas of clinical diagnosis and care to have the opportunity to apply digital dentistry. These tools can allow for more predictable, profitable, and pleasant treatment for our patients.SummaryAs our clinical landscape changes with the influx of digital tools, the uses, workflows, and clinical protocols associated with implant dentistry can be learned and applied in our daily clinical practice allowing for the streamlining and simplification of patient care.

Chairside repair of worn or lost denture teeth using nanofilled composite resin bonded to the denture base

1. Tsuo Y, Yoshida K, Atsuta M. Effects of alumina-blasting and adhesive primers on bonding between resin luting agent and zirconia ceramics. Dent Mater J 2006;25:66974. 2. Wolfart M, Lehmann F, Wolfart S, Kern M. Durability of the resin bond strength to zirconia ceramic after using different surface conditioning methods. Dent Mater 2007;23:45-50. 3. Kern M, Wegner SM. Bonding to zirconia ceramic: adhesion methods and their durability. Dent Mater 1998;14:64-71. 4. Kern M, Barloi A, Yang B. Surface conditioning influences zirconia ceramic bonding. J Dent Res 2009;88:817-22. 5. Derand T, Molin M, Kvam K. Bond strength of composite luting cement to zirconia ceramic surfaces. Dent Mater 2005;21:115862. 6. Aboushelib MN, Kleverlaan CJ, Feilzer AJ. Selective infiltration-etching technique for a strong and durable bond of resin cements to zirconia-based materials. J Prosthet Dent 2007;98:379-88. 7. Phark JH, Duarte S Jr, Blatz M, Sadan A. An in vitro evaluation of the long-term resin bond to a new densely sintered high-purity zirconium-oxide ceramic surface. J Prosthet Dent 2009;101:29-38. 8. Yang B, Wolfart S, Scharnberg M, Ludwig K, Adelung R, Kern M. Influence of contamination on zirconia ceramic bonding. J Dent Res 2007;86:749-53. Corresponding author: Dr Matthias Kern Department of Prosthodontics, Propaedeutics and Dental Materials School of Dentistry, Christian-Albrechts University at Kiel Arnold-Heller Strasse 16 24105 Kiel GERMANY Fax: +49 431 597 2860 E-mail: mkern@proth.uni-kiel.de