Técnica CAD/CAM comparado con técnica convencional en pacientes con indicación de restauración indirecta unitaria posterior / CAD/CAM versus conventional techniques for unitary posterior indirect restoration

RESUMEN: Introducción: La confección de restauraciones indirectas ha sido tradicionalmente realizada mediante técnicas convencionales de laboratorio, la cual involucra la realización de una serie de pasos y la necesidad de que el paciente asista a varias sesiones clínicas. En las últimas décadas ha sido incorporada la técnica CAD/CAM, la cual ha simplificado la confección de restauraciones indirectas. Es necesario comparar el desempeño clínico de ambas técnicas. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos tres revisiones sistemáticas que en conjunto incluyeron ocho estudios primarios, de los cuales, cinco corresponden a ensayos aleatorizados. Concluimos que la técnica CAD/CAM probablemente aumenta la falla de la restauración y la pérdida de retención. Por otra parte, podría disminuir levemente la pérdida de vitalidad y tener nula o poca diferencia en el riesgo de extracción dentaria, riesgo de caries secundaria y cambio de color superficial, pero la certeza de la evidencia es baja.

ABSTRACT: Introduction: Conventional laboratory techniques for indirect restoration involve multiple stages and several clinical sessions for patients. In the last decades, the CAD/CAM technique has been incorporated in clinical practice, simplifying the fabrication process of indirect restorations. A comparative assessment of the clinical performance of both techniques is required. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified three systematic reviews including eight studies overall, of which five were randomized trials. We conclude that CAD/CAM technique probably increase the risk of restoration failure and loss of retention. On the other hand, CAD/CAM technique may slightly reduce the risk of loss of vitality and may make little or no difference to the risk of tooth extraction, risk of secondary caries and superficial color change, but the certainty of the evidence is low.

Clinical observations of all-ceramic restorations of children’s first permanent molars with severe defects / 口腔疾病防治

Objective @#To explore the therapeutic efficacy of chairside CEREC all-ceramic restorations in children with first permanent molars with severe defects and to summarize the clinical methods and procedures.@*Methods@# Forty teeth of 7-15 years old thirty-four children with first permanent molars with severe defects were selected. After careful tooth preparation, a total of 40 all-ceramic restorations (8 inlays, 32 onlays) were designed and manufactured using the CEREC 3D system, and all prostheses were bonded with composite resin cement. Immediately after treatment and after 24 months, the subjective satisfaction of the patients was assessed. The clinical efficacy was analyzed using modified USPHS criteria at 12 months and 24 months. Evaluations included secondary caries, marginal adaptation, surface texture, color matching, fracture, anatomical form, adjacency relationship and gingival health.@*Results @# For the 40 all-ceramic restorations of the first permanent molars, after 24 months, 100% of the teeth were grade A for secondary caries, surface texture and fracture of the prosthesis, and 85% of the teeth were up to grade A for the other indexes at 12 and 24 months. There were no significant differences (P > 0.05) between 12 months and 24 months. Immediately after treatment and after 24 months, the subjective satisfaction of the patients was greater than 94%. @*Conclusion @#Application of the CEREC 3D system had a clear curative effect and resulted in high satisfaction in the repair of permanent molars with severe defects in children.

Polishing performance of different polishing tools for CEREC Blocs ceramic / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to compare the polishing performance of five different glass-ceramic polishing tools on CEREC Blocs ceramic and provide evidence for clinical polishing tool selection.</p><p><b>METHODS</b>Sixty ceramic specimens were prepared and divided into six groups (n=10). These specimens received different surface treatments, including glazing (group G), polishing with Shofu polishing set, that is, Porcelain Adjustment Kit+CeraMaster (group SF), 3M Sof-LexTM Discs (group 3M), TobooM polishing set (group Tob), EVE DIAPRO system (group EVE), and Ivoclar Vivadent OptraFine® system (group Ivo). Polishing quality was measured with a profilometer, and we selected Ra and Rz values for statistical analysis. Qualitative surface evaluation was performed by a scanning electron microscope (SEM).</p><p><b>RESULTS</b>The mean Ra values of each group were as follows: G (0.069 µm±0.008 µm)<3M (0.073 µm±0.009 µm)<SF (0.223 µm±0.025 µm)<Ivo (0.229 µm±0.022 µm)<EVE (0.491 µm±0.093 µm)<Tob (0.763 µm±0.067 µm). No significant difference was observed between G and 3M groups (P>0.05), and SF and Ivo groups (P>0.05), but the remaining treatment groups were significantly different from each other (P<0.05). Statistical results of Rz values were the same as the Ra values, and visual analysis of the images obtained from SEM was consistent with the statistical results.</p><p><b>CONCLUSIONS</b>The polishing performance of different polishing tools for CEREC Blocs ceramic was different. Sof-LexTM Discs achieved the most remarkable performance, which was comparable to that of glazing. 
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Influence of different cement spaces on marginal adaptation of CAD/CAM inlay / 口腔疾病防治

Objective@#To explore the influence of different cement spaces on the marginal adaptation of CAD/CAM zirconia inlay.@*Methods@#30 teeth extracted for orthodontic purpose were selected and divided into 3 groups (Group A 10 μm, Group B 30 μm, Group C 50 μm). The marginal spaces of inlays were recorded by the light-body Silicone impression material, and measured by microscope. The data were analyzed by SPSS 13.0.@*Results @# All the inlays fitted very well and all the marginal spaces were less than 120 μm. The shoulder of Group A was statistically lower than Group B and Group C (P < 0.05). The axial surface of Group B was statistically lower than Group C (P < 0.05).@*Conclusions @#CEREC zirconia inlay is satisfactory when the cement space is between 10-50 μm.

The influence of different digital impression technology on the accuracy of 3D printed models / 实用口腔医学杂志

Objective:To evaluate the accuracy of Cerec Bluecam and Cerec Omnicam with 3D printed resin models.Methods:A metal master model including 4 cylindrical metal preparations on the model base,respectively simulating the maxillary canine and the first molar preparations,was prepared.The right canine and the right first molar were respectively marked as A and B,and the left as C and D.The master model was scanned respectively by Cerec Bluecam and Cerec Omnicam for 10 times,10 digital models were genera-ted in Bluecam group and Omnnicam group respectively.Resin models were obtained by a 3D printer based on the digital models,the distance of AB,AC,BD and the diameter(d)of A were respectively measured.Statistical analysis was conducted by SPSS 13.0 soft-ware.Results:The distance of AB,AC,BD of master model and Bluecam group showed significant difference(P 0.05);the distance of AC,BD of master model and Omnicam group showed significant difference(P 0.05).All the distances of the Bluecam group and Omnicam group showed significant difference(P <0.05).Conclusion:The scanning accuracy of Cerec Bluecam is higher than that of Cerec Omnicam in a single preparation scanning.When the scanning area ex-tending,the scanning accuracy of Cerec Omnicam is higher than that of Cerec Bluecam.

Clinical effect of CEREC chairside on atypical ceramic inlay restoring class Ⅱ cavity / 中华医学美学美容杂志

Objective To evaluate the clinical effect of CEREC chairside on atypical porcelain inlay restoring class [[cavity.Methods 30 patients that required re-treatment because of resin restoration failure and early posterior proximal caries were selected randomly.The original fillings,secondary carious tissues and undercut parts were removed.The clear and round edge lines were prepared.With Sirona CEREC Blocs,35 atypical ceramic inlays were produced in accordance with CEREC AC CAD/CAM standard procedures.After clinical trial and modification,the inlays were bonded with 3M Veneer resin adhesive cement.Evaluation was done immediately and 3,6,12 and 24 months after restoration.Two senior prosthodontists did the evaluation according to the modified USPHS criteria.Results The evaluation results were all A when estimated immediately after restoration.None inlay falled off during the first two years.However,3 inlay were found to be damaged when reviewed at the 24th month.There exsited two patients having mild symptoms of dentine hypersensitivity which appeared at the beginning and died out gradually.Generally speaking,more than 90％ of inlay restorations had reached the USPHS criteria A.Color match and retention represented better effects.Conclusions CEREC atypical ceramic inlays can effectively restore Class Ⅱ cavity,short-term effect is good,but long-term effect still needs further observations.

Application of CEREC Bluecam digital impressions in tooth preparation of fixed bridge / 中华医学美学美容杂志

Objective To study CEREC Bluecam digital impressions in tooth preparation of fixed bridge.Methods Totally 80 patients of tooth preparation of 3 units fixed bridge were divided into experiment group (with CEREC Bluecam digital impressions system) and control group (with traditional method) randomly,and then captured the CEREC Bluecam digital impressions and made the dental models after the tooth preparation.Shoulders width,smooth and continuation of shoulders,paleness of shoulders edge,axial chamfers,axial converge degree,occlusal space and common path of insertion were analyzed.Results In the digital impressions in the equality of shoulders width,smooth and continuation of shoulders,paleness of shoulders edge,axial chamfers,axial converge degree,occlusal space and common path of insertion,the experiment group was better than control group:95.0％ (38 cases) vs.62.5％ (25 cases),92.5％ (37 cases) vs.77.5％ (31 cases),97.5％ (39 cases) vs.75.0％ (30 cases),95.0％ (38 cases) vs.72.5％ (29 cases),90.0％ (36 cases) vs.65.0％ (26 cases),100.0％ (40 cases) vs.52.5％ (21 cases),and 97.5％ (39 cases)vs.75.0％ (30 cases),respectively,all (P＜0.05).In the dental models,the experiment group was better than control group:87.5％ (35 cases) vs.60.0％ (24 cases),97.5％ (39 cases) vs.75.0％ (30 cases),90.0％ (36 cases) vs 62.5％ (25 cases),95.0％ (38 cases) vs 75.0％(30 cases),92.5％ (37 cases) vs 70.0％ (28 cases),100.0％ (40 cases) vs.72.5％ (29 cases),and 100.0％ (40 cases) vs.65.0％ (26 cases),respectively,(all P＜0.05).Conclusions The tooth preparation quality with the CEREC Bluecam digital impressions is better than that of the traditional method.

Shear bond strength of the three different kinds of resin cement on CAD/CAM ceramic inlay / 대한치과보철학회지

PURPOSE: The purpose of this study was to evaluate the bond strengths between the latest CAD/CAM ceramic inlay and various resin cements which are used primarily for esthetic restoration. MATERIALS AND METHODS: Cylindrical ceramic blocks(Height: 5 mm, diameter: 3 mm) were fabricated by using Cerec3 and bonded on the dentin of the ninety extracted caries-free molars using three different kinds of resin cement(Unicem(R), Biscem(R), and Variolink II(R)) according to the manufacturer's instructions. Ninety specimens were divided into 3 groups according to three different kinds of resin cement. Half of each group were conducted thermocycling under the conditions of the 5 - 55degrees C, 5,000 cycle but the other half of them weren't. All specimens were kept in normal saline 37degrees C, for 24 hours before measuring the bond strength. The shear bond strength was measured by Universal testing machine with a cross head speed of 0.5 mm/min. The results were analyzed statistically by t-test and one-way ANOVA. RESULTS: Unicem(R) group showed the highest shear bond strength despite a slight decline by thermocycling. The shear bond strength of Unicem(R) group and ValiolinkII(R) group were significantly influenced by thermocycling, whereas Biscem(R) group was not influenced (P<.05). There were no significant differences in the bond strength between the three groups without thermocycling, but there was significant differences between Unicem(R) group and Valiolink II(R) group with thermocycling(P<.05). CONCLUSION: It has been shown to be clinically effective when the self-adhesive resin cements Unicem(R) and Biscem(R) were used instead of the etch-and-rinse resin cement Valiolink II(R) during the bonding of CAD/CAM ceramic inlay restorations with teeth.

Adaptación marginal y ajuste interno en estructuras de zirconia-ytria elaboradas con los sistemas CAD/CAM Procera® y Cerec in-Lab® / Marginal adaptation and internal fit of zirconia-ytrya frameworks fabricated with Procera® and Cerec in-Lab® CAD/CAM systems

Introducción: el objetivo fue determinar ex vivo la adaptación marginal y ajuste interno en estructuras de zirconiaytria elaboradas con los sistemas CAD/CAM Procera® y Cerec In-lab®. Métodos: se tomaron 15 pilares protésicos prefabricados contorneados de implantes divididos en tres grupos. Se fabricaron estructuras en aleación noble Pd-Au (control), Procera AllZircon® y Cerec In-lab YZ cubes®. Para evaluar la adaptación marginal se tomaron ocho medidas en la circunferencia del pilar protésico, tomando la distancia entre el borde de la estructura y el pilar. Para determinar el ajuste interno se hicieron ocho medidas desde la superficie externa del pilar a la superficie interna de la restauración. Las mediciones fueron hechas por microscopia óptica (50X). Los datos obtenidos fueron analizados por medio del análisis de varianza de una vía, la t de Student y prueba de Dunnett. Resultados: el promedio de adaptación marginal del grupo control fue 18,24 μm ±4,81; el grupo Procera®21,62 μm ±12,15 y el grupo Cerec In-lab® de 47,34 μm ±17,72. El promedio de ajuste interno para las estructuras Pd-Au fue 34,60 μm ±16,16; Procera® 118,67 μm ±50,84 y el Cerec In-lab® 65,62 μm ±25,80. Conclusiones: los valores de adaptación marginal de las estructuras de aleación metálica y de zirconia-ytria elaboradas con los sistemas CAD/CAM Procera® y CerecIn-lab® están entre los valores clínicamente aceptables. Las medidas de ajuste interno obtenidos para los grupos aleación metálica y Cerec® se encuentran dentro del rango reportado en la literatura. Mientras que el promedio obtenido para el grupo Procera® 118,67 μm ±50,84, aunque se acercó al límite máximo de ajuste interno reportado en la literatura, no se evidenció diferencia estadísticamente significativa con el sistema Cerec In-lab®.

Introduction: the purpose of this in vitro study was to determine the marginal adaptation and internal fit in zirconia ytrya frameworks fabricated with Procera® and Cerec In-lab® CAD/CAM systems. Methods: fifteen prefabricated implant abutmentswere divided in three equally sized groups; noble metal alloy Pd-Au structures were then fabricated (control group), Procera® and Cerec In-lab YZ cubes® (n = 5). The marginal gap was determined by measuring 8 points around the abutment circumferencetaking the distance between the margin of the structure and the abutment. In order to determine internal fit, 8 measures were taken from the abutment´s external surface to the internal surface of the restoration. The measures were done with an opticalmicroscope (50X). The data was the statistically analyzed using 1-way ANOVA, Student’s paired t test and Dunnett´test. Results: marginal adaptation mean for the control group was 18.24±4.81μm and Procera® 21.62 μm ±12.15 μm, while the average for Cerec In-lab® was 47.34 μm ±17.72 μm. The internal fit for the control group was 34,60 μm ±16.16 μm and Procera® group was of 118.67 μm ±50.84 μm in average and Cerec In-lab® 65.62 μm ±25.80 μm. Conclusions: the metal alloy and zirconia ytrya frameworksfabricated with Procera® and Cerec In-lab® CAD/CAM systems showed clinically acceptable marginal gap values. The internal fit values for metal alloy and Cerec® frameworks are within the ranges reported in the literature. While the mean for the Procera®group was 118.67 μm ±50.84, which is close to the internal fit maximum limit reported in the literature, there was no statistically significant difference when compared with the Cerec-In-lab® system.

Influence of three different preparation designs on the marginal and internal gaps of CEREC3 CAD/CAM inlays / 대한치과보존학회지

The aim of this study was to evaluate the marginal and internal gaps in CEREC3 CAD/CAM inlays of three different preparation designs. CEREC3 Inlays of three different preparation designs (n = 10) were fabricated according to Group I-conventional functional cusp capping/shoulder preparation, Group II-horizontal reduction of cusps and Group III-complete reduction of cusps/shoulder preparation. After cementation of inlays, the bucco-lingual cross section was performed through the center of tooth. Cross section images of 20 magnifications were obtained through the stereomicroscope. The gaps were measured using the Leica application suite software at each reference point. Statistical analysis was performed using one-way ANOVA and Tukey's test (alpha<0.05). The marginal gaps ranged from 80.0 to 97.8 microm for Group I, 42.0 to 194.8 microm for Group II, 51.0 to 80.2 microm for Group III. The internal gaps ranged from 90.5 to 304.1 microm for Group I, 80.0 to 274.8 microm for Group II, 79.7 to 296.7 microm for Group III. The gaps of each group were the smallest on the margin and the largest on the horizontal wall. For the CEREC3 CAD/CAM inlays, the simplified designs (groups II and III) did not demonstrate superior results compared to the traditional cusp capping design (group I).

Anti-fracture strength of teeth with wedge-shaped defects repaired with CEREC CAD/CAM ceramic inlay / 第三军医大学学报

Objective To study the effect of CEREC CAD/CAM ceramic inlay on repair of wedge-shaped defects of teeth and test its anti-fracture properties. Methods Extracted teeth were divided into control group ( n = 16) and experimental group ( n = 16) ,and prepared into imitating teeth with wedge-shaped defects. Teeth in experimental and control groups were repaired with CEREC CAD/CAM ceramic inlay and light-cured composite resin,respectively. Anti-fracture strength of teeth with wedge-shaped defects repaired with CEREC CAD/CAM was assayed on a universal testing device with its maximal loading recorded. The anti-fracture strength was compared between the 2 groups. Results The anti-fracture strength of teeth with wedge-shaped defects repaired with CEREC CAD/CAM ceramic inlay was significantly higher in experimental group than in control group ( 3. 56 ? 0. 27 vs 2. 43 ? 0. 15,P

Experimental study of fracture loading test of cracked teeth with CEREC CAD/CAM ceramic inlays/onlays / 第三军医大学学报

Objective To test the fracture loading of extracted cracked teeth with CEREC CAD/CAM ceramic inlays/onlays. Methods All the extracted teeth were divided into two groups (A: control group; B: test group; n=15 teeth in each group). All the teeth were prepared into those imitating cracked teeth. Those teeth in group B were strengthened with CEREC CAD/CAM ceramic inlays/onlays. All teeth were thermocycled and mounted for testing and then were loaded until fracture. Results The force of anti-fracture of extracted teeth imitating cracked teeth with CEREC CAD/CAM ceramic inlays/onlays (group B) was obviously higher than that of the teeth without CEREC CAD/CAM ceramic inlays/onlays (group A). Conclusion CEREC CAD/CAM ceramic inlays/onlays can effectively prevent the crack of teeth in clinical practice.

Electroplated method for making diamond-coated grinding discs and burrs used on CEREC II CAD/CAM system / 实用口腔医学杂志

?Objective: To develop the electroplated diamond grinding discs and burrs used on CEREC II CAD/CAM system. Methods: Using electroplated technology, the diamond grain and nickel were deposited together on the surface of stainless steel discs and burrs and then a composite electroplated diamond layer was formed, which was the method that diamond coated grinding discs and burrs were made. The experimental grinding discs and burrs were used to mill porcelain blocks on CEREC II CAD/CAM system and were compared with CEREC discs and burrs. Results: There were no significant differences between the experimental samples and CEREC samples on milling property and durability. Conclusion: The electroplated technology is simple and feasible. The diamond coated grinding discs and burrs made with this method can be used on CEREC II CAD/CAM system, but the further investigation is also needed.