Full mouth rehabilitation of a severely worn dentition using intraoral scanner and the CAD/CAM double scanning technique / 대한치과보철학회지

With the evolution of the computer-aided design/computer-aided manufacturing (CAD/CAM) technology, the intraoral scanners are playing an increasingly important role, as they are the first step towards a completely digital workflow. The CAD/CAM double scanning technique has been used to transfer the information from provisional restorations to definitive restorations. In this case, a 67-year-old male with esthetically compromised anterior teeth, generalized severe attrition of teeth, and reduced vertical dimension was treated with full mouth rehabilitation including a re-establishment of the lost vertical dimension of occlusion assisted by the crown lengthening procedure. The provisional restorations were fabricated using an intraoral scanner and the CAD/CAM double scanning technique. After the period of adaption, the definitive monolithic zirconia restorations were delivered. The CAD/CAM double scanning technique successfully transferred the occlusal and morphological characteristics, obtained from the provisional restorations, to the definitive restorations.

Full mouth rehabilitation utilizing computer guided implant surgery and CAD/CAM / 대한치과보철학회지

Computer aided design and manufacturing and implant surgery using a guide template improve restoration-driven implant treatment procedures. This case utilized those digital technologies to make definitive prostheses for a patient. According to the work flow of digital dentistry, cone beam computed tomography established the treatment plan, which was followed to make the guide template for implant placement. The template guided the implants to be installed as planned. The customized abutments and surveyed fixed restorations were digitally designed and made. The metal framework of the removable partial denture was cast from resin pattern using an additive manufacturing technique, and the artificial resin teeth were replaced with the zirconia onlays for occlusal stability. These full mouth rehabilitation procedures provided functionally and aesthetically satisfactory results for the patient.

Full mouth rehabilitation of a patient using monolithic zirconia and dental CAD/CAM system: a case report

An accurate implant placement with ideal location is significant for long-term success of the implant. An exact evaluation of nearby anatomic structures such as quality of residual bone, an inferior alveolar bone and a maxillary sinus is required. For a prosthetic-driven treatment, planned surgery, precise prosthesis and communication with the patient are significant requisites especially for full-mouth rehabilitation. In this case, the patient with severe alveolar bone resorption had a CT guided surgery supported by CT data and the data from scanning diagnostic wax-up. Afterward, edentulous area was restored by full mouth implant-supported prosthesis by using monolithic zirconia and CAD/CAM technique. This paper reports the outcome of the procedure which was remarkable both esthetically and functionally.

Full mouth rehabilitation with Implant-Guided Surgery and Fixed prosthesis / 대한치과보철학회지

The development of cone beam computerized tomography (CBCT) allows three-dimensional analysis of the patient's anatomy. The surgical guide is a combination of CBCT, computer-aided design/computer-aided manufacturing (CAD/CAM) and implant diagnostics software, which allows well planned prostheses design and ideal implant placement. Guided surgery minimizes possible anatomical damage and allows for more reproducible treatment planning. In this case, the operation time was shortened by using a surgical guide for multiple implants placement in a fully edentulous patient. Immediate loading were performed more easily using preliminary preparation of provisional prosthesis. The patient was satisfied with improved esthetics and chewing function.

Aesthetic restoration n patients with unaesthetic maxillary anterior teeth using double scan : A case report / 대한치과보철학회지

In case of the treatment of maxillary anterior teeth, it should be taken into account the proper morphology, arrangement and color satisfying patient's esthetic demands. For this purpose, facial composition, dentofacial composition, dental composition and dentogingival composition should be considered making diagnosis and treatment plan in an esthetic point of view. In adjustable temporary crown state, careful evaluation and correction of the esthetic and functional aspect were performed, and the definite restoration was reproduced using double scan.

Trueness and precision of scanning abutment impressions and stone models according to dental CAD/CAM evaluation standards

PURPOSE: The purpose of the present study was to compare scanning trueness and precision between an abutment impression and a stone model according to dental computer-aided design/computer-aided manufacturing (CAD/CAM) evaluation standards. MATERIALS AND METHODS: To evaluate trueness, the abutment impression and stone model were scanned to obtain the first 3-dimensional (3-D) stereolithography (STL) file. Next, the abutment impression or stone model was removed from the scanner and re-fixed on the table; scanning was then repeated so that 11 files were obtained for each scan type. To evaluate precision, the abutment impression or stone model was scanned to obtain the first 3-D STL file. Without moving it, scanning was performed 10 more times, so that 11 files were obtained for each scan type. By superimposing the first scanned STL file onto the other STL files one by one, 10 color-difference maps and reports were obtained; i.e., 10 experimental scans per type. The independent t-test was used to compare root mean square (RMS) data between the groups (α=.05). RESULTS: The RMS±SD values of scanning trueness of the abutment impression and stone model were 22.4±4.4 and 17.4±3.5 µm, respectively (P < .012). The RMS±SD values of scanning precision of the abutment impression and stone model were 16.4±2.9 and 14.6±1.6 µm, respectively (P=.108). CONCLUSION: There was a significant difference in scanning trueness between the abutment impression and stone model, as evaluated according to dental CAD/CAM standards. However, all scans showed high trueness and precision.

Effect of coloring agent on the color of zirconia / 대한치과보철학회지

PURPOSE: The aim of this study was to evaluate the effect of two types of coloring agents and the number of application on the color of zirconia. MATERIALS AND METHODS: Monolithic zirconia specimens (15.7 mm × 15.7 mm × 2.0 mm) (n = 33) was prepared and divided into 11 groups. Each experimental group was coded as a1-a5, w1-w5 according to the type of coloring agent and number of application. Specimens with no coloring agent applied were set as control group. The color difference of specimen was measured by using double-beam spectrophotometer, and calculated color difference (ΔE*(ab)), translucency parameter (TP). All data was analyzed with two-way ANOVA, multiple comparison Schéffe test, Pearson correlation and linear regression analysis. RESULTS: As the number of application increased, values of CIE L* was decreased, but values of CIE b* was increased in both coloring agents. However, there was no significant difference on values of translucency parameter. The color difference range of each group was 0.87 ΔE*(ab) to 9.43 ΔE*(ab). CONCLUSION: In this study, type of coloring agent and the number of application did not affect the color difference of zirconia.

CAD/CAM fabricated complete denture using 3D face scan: A case report / 대한치과보철학회지

In the past, computer-aided design/computer-aided manufacturing (CAD/CAM) technology was the closed system that users had to use the components of only one manufacturer. At present, it has changed to the open system with the flexibility to select and use the components of various manufacturers' components according to their needs. Despite the development of dental materials and prostheses manufacturing methods, denture manufacturing has followed conventional manufacturing methods for nearly 100 years. However, studies on CAD/CAM fabricated denture have been recently carried out to overcome the disadvantages of conventional denture manufacturing. Some commercialized products using milling or 3D printing have already been applied clinically. This case report confirms the possibility of CAD/CAM dentures using 3D face scan and compared them to conventionally fabricated dentures.

Rehabilitation using twin-stage method for a Sjögren's syndrome patient with severe discoloration and attrition on upper and lower anterior teeth / 대한치과보철학회지

Patients with Sjögren's syndrome usually suffer from teeth discoloration and attrition due to xerostomia. If the anterior teeth are badly worn, problems such as loss of anterior guidance, occlusal disharmony, and limited space for restoration may occur. However, ideal occlusion is obtained in both centric and eccentric relation by regaining the disocclusion of the posterior teeth through the anterior and lateral guidance using twin-stage method. In this case, rehabilitation was performed for a Sjögren's syndrome patient with maxillary and mandibular incisor's severe attrition and teeth discoloration by using twin-stage method.

Rehabilitation using twin-stage method for a Sjögren's syndrome patient with severe discoloration and attrition on upper and lower anterior teeth / 대한치과보철학회지

Patients with Sjögren's syndrome usually suffer from teeth discoloration and attrition due to xerostomia. If the anterior teeth are badly worn, problems such as loss of anterior guidance, occlusal disharmony, and limited space for restoration may occur. However, ideal occlusion is obtained in both centric and eccentric relation by regaining the disocclusion of the posterior teeth through the anterior and lateral guidance using twin-stage method. In this case, rehabilitation was performed for a Sjögren's syndrome patient with maxillary and mandibular incisor's severe attrition and teeth discoloration by using twin-stage method.

Fabrication of computer-aided design/computer-aided manufacturing complete denture and conventional complete denture: case report

Recently computer-aided technology has been widely used in dentistry. DENTCA™ CAD/CAM denture system (DENTCA Inc.), one of CAD/CAM systems for fabricating complete denture, tries to collect and store all of a patient's information at the first visit. This system aims to deliver denture at the second visit through utilizing the CAD/CAM software to access the stored data for designing the 3D denture model. The 3 dimensional (3D) denture will then be fabricated with 3D printer. Many case reports have evaluated clinical application of CAD/CAM system for fabricating complete dentures. This case report is about fabricating of complete dentures using DENTCA system and conventional method in same patient. With two cases, usefulness and limitation of DENTCA system could be evaluated.

Shear bond strength of dental CAD-CAM hybrid restorative materials repaired with composite resin / 대한치과보철학회지

PURPOSE: This study was performed in order to assess the effect of the surface treatment methods and the use of bonding agent on the shear bond strength (SBS) between the aged CAD-CAM (computer aided design-computer aided manufacturing) hybrid materials and added composite resin. MATERIALS AND METHODS: LAVA Ultimate (LU) and VITA ENAMIC (VE) specimens were age treated by submerging in a 37℃ water bath filled with artificial saliva (Xerova solution) for 30 days. The surface was ground with #220 SiC paper then the specimens were divided into 9 groups according to the combination of the surface treatment (no treatment, grinding, air abrasion with aluminum oxide, HF acid) and bonding agents (no bonding, Adper Single Bond 2, Single Bond Universal). Each group had 10 specimens. Specimens were repaired (added) using composite resin (Filtek Z250), then all the specimens were stored for 7 days in room temperature distilled water. SBS was measured and the fractured surfaces were observed with a scanning electron microscope (SEM). One-way ANOVA and Scheffe test were used for statistical analysis (α=.05). RESULTS: Mostly groups with bonding agent treatment showed higher SBS than groups without bonding agent. Among the groups without bonding agent the groups with aluminum oxide treatment showed higher SBS. However there was no significant difference between groups except two subgroups within LU group, which revealed a significant increase of SBS when Single Bond Universal was used on the ground LU specimen. CONCLUSION: The use of bonding agent when repairing an aged LAVA Ultimate restoration is recommended.

Evaluation of marginal and internal gap under model-free monolithic zirconia restoration fabricated by digital intraoral scanner / 대한치과보철학회지

PURPOSE: The aim of this study was to evaluate the marginal and internal adaptation of monolithic zirconia restoration made without physical model by digital intraoral scanner. MATERIALS AND METHODS: A prospective clinical trial was performed on 11 restorations as a pilot study. The monolithic zirconia restorations were fabricated after digital intraoral impression taking by intraoral scanner (TRIOS, 3shape, Copenhagen, Denmark), computer-aided designing, and milling manufacturing process. Completed zirconia crowns were tried in the patients' mouth and a replica technique was used to acquire the crown-abutment replica. The absolute marginal discrepancy, marginal gap, and internal gap of axial, line angle, and occlusal part were measured after sectioning the replica in the mesiodistal and buccolingual direction. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U test (α=.05). RESULTS: From the adaptation analysis by replica, the statistically significant difference was not found between mesiodistal and buccolingual sections (P>.05), but there was significant difference among the measurement location (P<.01). The amount of absolute marginal discrepancy was larger than those of marginal gap and internal gap (P<.01). CONCLUSION: Within the limitations of this study, the adaptation accuracy of model-free monolithic zirconia restoration fabricated by intraoral scanner exhibited clinically acceptable result. However, the margin of zirconia crown showed tendency of overcontour and cautious clinical application and follow up is necessary.

Comparison of micro CT and cross-section technique for evaluation of marginal and internal fit of lithium disilicate crowns / 대한치과보철학회지

PURPOSE: The purpose of this study was to evaluate the adaptation of lithium disilicate crowns fabricated by CAD-CAM (computer aided design-computer aided manufacturing) and heat-press technique to compare two different measurement methods in assessing fit of the ceramic crowns: micro CT and cross-section technique. MATERIALS AND METHODS: A prepared typodont mandibular molar for ceramic crown was duplicated and ten dies were produced by milling the PMMA (polymethylmethacrylate) resin. Ten vinyl polysiloxane impressions were made and stone casts were produced. Five dies were used for IPS e.max Press crowns with heat-press technique. The other five dies were used for IPS e.max CAD crowns with CAD-CAM technique. Ten lithium disilicate crowns were cemented on the resin dies using zinc phosphate cement with finger pressure. The marginal and internal fits in central buccolingual plane were evaluated using a micro CT. Then the specimens were embedded and cross-sectioned and the marginal and internal fits were measured using scanning electronic microscope. The two measurement methods and two manufacturing methods were compared using Mann-Whitney U test (SPSS 22.0). RESULTS: The marginal and internal fit values using micro CT and cross-section technique were similar, showing no significant differences. There were no significant differences in adaptation between lithium disilicate crowns fabricated with CAD-CAM and heat-press technique. CONCLUSION: Both micro CT and cross-section technique were acceptable methods in the evaluation of marginal and internal fit of lithium disilicate crown. There was no difference in adaptation between lithium disilicate crowns fabricated with CAD-CAM and heat-press technique except occlusal fit.

Comparison of crown designs of different dental occupational groups, using CAD-CAM / 대한치과보철학회지

PURPOSE: Increasing use of computer aided design-computer aided manufacturing (CAD-CAM) system and number of design software made design of restoration easy and quick. Outcome of restoration has been dependent on dental technician's wax up proficiency, dentists can design restoration for themselves now. This study aims to investigate the outcome of restoration designs, according to handling skill of CAD-CAM design tool. MATERIALS AND METHODS: A patient's mandibular right 1st molar was prepared. After taking impression, stone model was made, scanned the stone model with 3 shape intra-oral scanner, stereolithography (STL) file was extracted. With 3shape dental designer, one dental technician with more than 5 years work experience (designer 0) and three dental technicians with less than 2years work experience (designer 1, 2, 3-group DT) and 4 1st year residents (designer 4, 5, 6, 7-group RT) designed gold crown on the same STL file. Designed crown's MD (mesio-distal) and BL (bucco-lingual) diameter, height of crown, inter-cuspal distance, number of occlusal contact points were compared. Statistical analysis was carried out, test of normality within each group, using independent t-test. Number of contact points were compared, using Wilcoxon signed-rank test. RESULTS: There was no significant difference between group DT and group RT. Number of contact points also resulted in no significant difference. CONCLUSION: The outcome of each designed crowns showed no statistical differences, in values which can be expressed as numbers. Subjective factors were different. With increasing proficiency in handling designing software, fabrication of restorations according to each designer's occlusal concept can be made easy.

Superimposition: a simple method to minimize occlusal adjustment of monolithic restoration / 대한치과보철학회지

The development of translucent zirconia enabled clinicians to choose a monolithic zirconia crown as one treatment modality in the posterior dentition. Careful occlusal adjustments are recommended for monolithic zirconia crowns because grinding zirconia inevitably causes phase transformation, which may deteriorate mechanical properties. intraoral scanners enable the clinician to scan and superimpose a complete tooth structure before preparation onto the prepared abutment. This technique helps to reproduce the original tooth form and occlusion of the patient. In this case report, prostheses were fabricated for patients with cracked or fractured tooth by applying intraoral scanner, Computer aided design-computer aided manufacturing (CAD-CAM) and monolithic zirconia crown to reproduce the occlusion of original tooth and to minimize occlusal adjustment. The clinical results were satisfactory in both esthetic and functional aspects.

Mandibular implant-supported overdenture using CAD-CAM Konus type attachment: A case report / 대한치과보철학회지

In edentulous mandible, implant supported overdenture was considered as a first treatment option. Konus type attachment supplies rigid support and cross arch stabilization so that more favorable force transmission and distribution can be attained. In the dentistry, computer aided design-computer aided manufacturing (CAD-CAM) system makes it possible to fabricate restorations with high precision and effectiveness. Recently, Palladium-silver (Pd-Ag) alloy which is millable has been developed. This article presents that application of CAD-CAM Konus type attachment can be provide satisfactory stability and function on four-implant supported mandibular overdenture.

Microtensile bond strength and micromorphologic analysis of surface-treated resin nanoceramics

PURPOSE: The aim of this study was to evaluate the influence of different surface treatment methods on the microtensile bond strength of resin cement to resin nanoceramic (RNC). MATERIALS AND METHODS: RNC onlays (Lava Ultimate) (n=30) were treated using air abrasion with and without a universal adhesive, or HF etching followed by a universal adhesive with and without a silane coupling agent, or tribological silica coating with and without a universal adhesive, and divided into 6 groups. Onlays were luted with resin cement to dentin surfaces. A microtensile bond strength test was performed and evaluated by one-way ANOVA and Tukey HSD test (α=.05). A nanoscratch test, field emission scanning electron microscopy, and energy dispersive X-ray spectroscopy were used for micromorphologic analysis (α=.05). The roughness and elemental proportion were evaluated by Kruskal–Wallis test and Mann–Whitney U test. RESULTS: Tribological silica coating showed the highest roughness, followed by air abrasion and HF etching. After HF etching, the RNC surface presented a decrease in oxygen, silicon, and zirconium ratio with increasing carbon ratio. Air abrasion with universal adhesive showed the highest bond strength followed by tribological silica coating with universal adhesive. HF etching with universal adhesive showed the lowest bond strength. CONCLUSION: An improved understanding of the effect of surface treatment of RNC could enhance the durability of resin bonding when used for indirect restorations. When using RNC for restoration, effective and systemic surface roughening methods and an appropriate adhesive are required.