Status of current CAD/CAM technology in dental medicine.

This article provides an overview of the status of current CAD/CAM technology and possible development trends. In addition to a description of the different CAD/CAM components required for producing computer-assisted dental restorations, innovative design methods recently introduced into dental technology are also mentioned. In the description of the practical application of the current CAD/CAM systems, the possibilities and limits of the present-day techniques and future outlook are illustrated. In this context, the current range of materials available for the computer-assisted production of biocompatible and at the some time high-quality dental restorations is also discussed. In conclusion, the different economic concepts coming into consideration in view of the high investment costs of the current CAD/CAM systems are presented and discussed.

Marginal fit of alumina-and zirconia-based fixed partial dentures produced by a CAD/CAM system.

Clinical long-term success of all-ceramic dental restorations can be significantly influenced by marginal discrepancies. As a result, this in vitro study evaluated the marginal fit of alumina- and zirconia-based fixed partial dentures (FPDs) machined by the Precident DCS system. Different master steel models of three-, four- and five-unit posterior FPDs with an 0.8 mm chamfer preparation were produced. FPDs made of DC-Zirkon and In-Ceram Zirconia core ceramics were machined by the Precident DCS system. The marginal fit of the milled frameworks placed on the master steel models was determined by a replica technique using a light-body silicone to fill the discrepancies between crown and tooth and a heavy-body material to stabilize the light-body impression material. The impressions were poured into an epoxy resin material and each model was cross-sectioned with a low speed diamond saw to better visualize marginal discrepancies. The marginal fit of the FPDs was evaluated by scanning electron microscopy. The measurements of the marginal fit exhibited mean marginal discrepancies in a range between 60.5 and 74.0 microm, mean marginal gaps in a range from 42.9 to 46.3 microm, mean vertical discrepancies in a range from 20.9 to 48.0 microm and mean horizontal discrepancies in the range of 42.0 to 58.8 microm. Statistical data analysis was performed using the non-parametric test of Kruskal-Wallis and Mann-Whitney. The analysis revealed no significant differences (p>0.05) between the mean marginal gaps and vertical and horizontal discrepancies. However, for some FPDs the mean values of the marginal discrepancies were significantly different (p < or =0.05). The wide range of the measured values may be attributed to the complex geometrical design of long span FPDs and difficulties regarding the milling process of brittle ceramic materials. Based on the selection of 100 microm as the limit of clinical acceptability, the results of this study can conclude that the level of marginal fit for alumina- and zirconia-based FPDs achieved with the Precident DCS system meet the clinical requirements.

Fracture resistance of lithium disilicate-, alumina-, and zirconia-based three-unit fixed partial dentures: a laboratory study.

PURPOSE: The purpose of this study was to determine the fracture resistance of three-unit fixed partial dentures (FPD) made of new core ceramics. MATERIALS AND METHODS: A base metal three-unit master FPD model with a maxillary premolar and molar abutment was made. Tooth preparation showed 0.8-mm circumferential and 1.5-mm occlusal reduction and a chamfer margin design. FPDs were constructed with a uniform 0.8-mm-thick core ceramic and a porcelain veneer layer. In-Ceram Alumina, In-Ceram Zirconia, and DC-Zirkon core ceramics were machined by a computer-aided design/manufacturing system, whereas IPS Empress 2 core ceramic was indirectly built up using the fabrication technology of waxing and heat pressing. FPDs of IPS Empress were heat pressed as complete restorations without core material. To ensure standardized dimensions, the FPDs were controlled at different points. All FPDs were cemented with ZnPO4 on the master model and loaded on a universal testing machine until failure. The failure load and mode of failure were recorded. RESULTS: The highest failure loads, exceeding 2,000 N, were associated with FPDs of DC-Zirkon. FPDs of IPS Empress and In-Ceram Alumina showed the lowest failure loads, below 1,000 N, whereas intermediate values were observed for FPDs of IPS Empress 2 and In-Ceram Zirconia. Differences in mean values were statistically significant. CONCLUSION: The high fracture resistance evaluated for FPDs made of DC-Zirkon underscores the remarkable mechanical properties of high-performance ceramic, which could be useful for highly loaded all-ceramic restorations, especially in the molar region.

Application of laser measuring, numerical simulation and rapid prototyping to titanium dental castings.

OBJECTIVES: This paper describes a method of making titanium dental crowns by means of integrating laser measuring, numerical simulation and rapid prototype (RP) manufacture of wax patterns for the investment casting process. METHODS: Four real tooth crowns (FDI No. 24, 25, 26, 27) were measured by means of 3D laser scanning. The laser digitized geometry of the crowns was processed and converted into standard CAD models in STL format, which is used by RP systems and numerical simulation software. Commercial software (MAGMASOFT) was used to simulate the casting process and optimize the runner and gating system (sprue) design. RP crowns were 'printed' directly on a ModelMaker II 3D Plotting System. A silicone negative mold (soft tool) was made from the RP crowns, then more than hundreds wax crowns were duplicated. The duplicated crowns were joined to the optimized runner and gating system. By using the investment casting process 20-25 replicas of each crown were made on a centrifugal casting machine. All castings were examined for porosity by X-ray radiographs. RESULTS: By using the integrated scanning, simulation, RP pattern and casting procedure, cast crowns, free of porosity, with excellent functional contour and a smooth surface finish, were obtained from the first casting trial. SIGNIFICANCE: The coupling of laser digitizing and RP indicates a potential to replace the traditional 'impression taking and waxing' procedure in dental laboratory, with the quality of the cast titanium prostheses also being improved by using the numerically optimized runner and gating system design.

Structural reliability of alumina-, feldspar-, leucite-, mica- and zirconia-based ceramics.

OBJECTIVES: The objective of this study was to test the hypothesis that industrially manufactured ceramic materials, such as Cerec Mark II and Zirconia-TZP, have a smaller range of fracture strength variation and therefore greater structural reliability than laboratory-processed dental ceramic materials. METHODS: Thirty bar specimens per material were prepared and tested. The four-point bend test was used to determine the flexure strength of all ceramic materials. The fracture stress values were analyzed by Weibull analysis to determine the Weibull modulus values (m) and the 1 and 5% probabilities of failure. RESULTS: The mean strength and standard deviation values for these ceramics are as follows: (MPa+/-SD) were: Cerec Mark II, 86.3+/-4.3; Dicor, 70.3+/-12.2; In-Ceram Alumina, 429. 3+/-87.2; IPS Empress, 83.9+/-11.3; Vitadur Alpha Core, 131.0+/-9.5; Vitadur Alpha Dentin, 60.7+/-6.8; Vita VMK 68, 82.7+/-10.0; and Zirconia-TZP, 913.0+/-50.2. There was no statistically significant difference among the flexure strength of Cerec Mark II, Dicor, IPS Empress, Vitadur Alpha Dentin, and Vita VMK 68 ceramics (p>0.05). The highest Weibull moduli were associated with Cerec Mark II and Zirconia-TZP ceramics (23.6 and 18.4). Dicor glass-ceramic and In-Ceram Alumina had the lowest m values (5.5 and 5.7), whereas intermediate values were observed for IPS-Empress, Vita VMK 68, Vitadur Alpha Dentin and Vitadur Alpha Core ceramics (8.6, 8.9, 10.0 and 13.0, respectively). CONCLUSIONS: Except for In-Ceram Alumina, Vitadur Alpha and Zirconia-TZP core ceramics, most of the investigated ceramic materials fabricated under the condition of a dental laboratory were not stronger or more structurally reliable than Vita VMK 68 veneering porcelain. Only Cerec Mark II and Zirconia-TZP specimens, which were prepared from an industrially optimized ceramic material, exhibited m values greater than 18. Hence, we conclude that industrially prepared ceramics are more structurally reliable materials for dental applications although CAD-CAM procedures may induce surface and subsurface flaws that may adversely affect this property.

In vitro studies on the effect of cleaning methods on different implant surfaces.

The effect of specific cleaning procedures was examined on the surfaces of 3 implant types with different coatings and shapes (plasma sprayed [PS]; hydroxyapatite coated [HA] implants; and smooth titanium surface screws) using a scanning electron microscope. Each implant was treated for 60 seconds per instrument with one of 6 different hygiene measures: plastic curet, metal curet, diamond polishing device, ultrasonic scaler, air-powder-water spray with sodium hydrocarbonate solution, and chlorhexidine 0.1% solution rinse. The air-powder-abrasive system, chlorhexidine rinse, and curettage with a plastic instrument caused little or no surface damage in all but the hydroxyapatite-coated fixtures. Therefore, these 3 methods were tested to determine their cleaning efficacy in a second clinical study, which did not include the HA-coated fixture. Two implants were placed on the facial aspects of both upper molar regions using individual acrylic plates. Thus, 2 fixtures on each side were examined in each patient. The examination revealed that only the sodium hydrocarbonate spray yielded a clean fixture without damage to the implant surface. In a third stage, which imitated the clinical procedure of the second approach, the cell growth of mouse-fibroblasts on implant surfaces was examined after cleaning the surface with plastic scaler and the air-abrasive system, which represents the least damaging and most effective methods. In contrast to the implant surfaces treated with plastic scalers, mostly vital cells were found on implants sprayed with the air-abrasive system.

The effect of corrosive environment on the porcelain-to-metal bond--a fracture mechanics investigation.

Microcracks, flaws, and voids inside a metal-porcelain restoration may cause the restoration to fracture in service. Such cracks result in the concentration of stresses. The dynamic nature of the stresses due to mastication promotes crack growth. In addition, corrosive components of the oral environment enhance the growth rate. In the present investigation, fracture mechanics has been used to analyze the in vitro resistance to fracture of the porcelain-fused-to-metal restoration. The risk of a clinical failure of porcelain-fused-to-metal decreases with enlarged crack resistance (increasing work of fracture). The work of fracture represents an average of the energy for initiation and propagation of a crack through the interface separating porcelain and metal. This work also indicates a material's ability to stop a crack once it is moving. This study utilized the three-point bending test for the crack resistance measurement, and investigated one palladium and five base metal alloys. Corrosive components of the oral environment and the details of firing were of crucial importance for long-term bond stability.