Accuracy of digitally fabricated trial dentures.

STATEMENT OF PROBLEM: Information about the accuracy of digital computer-aided design and computer-aided manufacturing (CAD-CAM) complete dentures is scarce. PURPOSE: The purpose of this in vitro study was to assess the reproducibility of the occlusion of wax dentures fabricated with digital steps and the contraction behavior of wax trial dentures processed with combined conventional-digital steps. These were compared with those fabricated completely conventionally in terms of storage duration. MATERIAL AND METHODS: Five sets of maxillary and mandibular wax trial dentures were milled from a gingiva-colored wax blank (Ceramill D-Wax, Amann Girrbach AG) using the Ceramill Motion 2 System (Amann Girrbach), scanned, and matched by best-fit triangulation for each of the 5 denture pairs. Processing deformation was measured and the maximum deviations calculated. A 3-dimensional color-coded mapping of the differences between each pair of dentures was generated. Five sets of maxillary and mandibular wax trial dentures were processed with digital steps, and 5 sets of maxillary and mandibular wax trial dentures were fabricated in the conventional way with the help of a silicone index from a CAM-fabricated wax trial denture to standardize the wax amount. All dentures were scanned immediately after waxing and after 1 week of storage. After surface matching, the deformation was measured, and the milled wax bases were compared with those conventionally fabricated. Data were interpreted using descriptive statistics. RESULTS: The occlusion of wax trial dentures fabricated with digital steps was not reproducible. The deviations in the maxillary dentures were mostly marginal, with exceptions for single teeth/tooth groups in denture No. 2 (occlusal areas of teeth in second quadrant, second molars) and No. 4 (central incisor and canine in second quadrant inclined to palatal side, and first premolar in first quadrant and first molar in second quadrant displayed greater deviations). Among the mandibular dentures, denture Nos. 4 and 5 the central incisor (fourth quadrant) inclined to the labial side. Additionally, in denture No. 5 the lateral incisor (fourth quadrant) inclined to the lingual side. CONCLUSIONS: In digitally fabricated dentures, the manual placing of the teeth into the denture base sockets can lead to deviations from the planned arrangement. The deviations were greater in the area of the denture bases in the conventionally fabricated dentures compared with those processed with combined conventional-digital steps. The milled wax bases showed better contraction behavior than the conventionally fabricated wax bases.

Accuracy of Digitally Fabricated Wax Denture Bases and Conventional Completed Complete Dentures.

The purpose of this investigation was to analyze the accuracy of digitally fabricated wax trial dentures and conventionally finalized complete dentures in comparison to a surface tessellation language (STL)-dataset. A generated data set for the denture bases and the tooth sockets was used, converted into STL-format, and saved as reference. Five mandibular and 5 maxillary denture bases were milled from wax blanks and denture teeth were waxed into their tooth sockets. Each complete denture was checked on fit, waxed onto the dental cast, and digitized using an optical laboratory scanning device. The complete dentures were completed conventionally using the injection method, finished, and scanned. The resulting STL-datasets were exported into the three-dimensional (3D) software GOM Inspect. Each of the 5 mandibular and 5 maxillary complete dentures was aligned with the STL- and the wax trial denture dataset. Alignment was performed based on a best-fit algorithm. A three-dimensional analysis of the spatial divergences in x-, y- and z-axes was performed by the 3D software and visualized in a color-coded illustration. The mean positive and negative deviations between the datasets were calculated automatically. In a direct comparison between maxillary wax trial dentures and complete dentures, complete dentures showed higher deviations from the STL-dataset than the wax trial dentures. The deviations occurred in the area of the teeth as well as in the distal area of the denture bases. In contrast, the highest deviations in both the mandibular wax trial dentures and the mandibular complete dentures were observed in the distal area. The complete dentures showed higher deviations on the occlusal surfaces of the teeth compared to the wax dentures. Computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated wax dentures exhibited fewer deviations from the STL-reference than the complete dentures. The deviations were significantly greater in the vicinity of the denture teeth area and the bases. The conventional transfer of CAD/CAM-fabricated wax dentures into acrylic resin leads to the highest deviations from the STL-reference.

Two-body wear rate of PEEK, CAD/CAM resin composite and PMMA: Effect of specimen geometries, antagonist materials and test set-up configuration.

OBJECTIVE: To test and compare the two-body wear rate of three CAD/CAM polymer materials and the influence of specimen geometry, antagonist material and test set-up configuration. METHODS: Three CAD/CAM polymeric materials were assessed: a thermoplastic polyetheretherketone (PEEK), an experimental nanohybrid composite (COMP) and a PMMA-based material (PMMA). Crown-shaped and flat specimens were prepared from each material. The specimens underwent thermo-mechanical loading (50N, 5/55°C; 600,000 chewing cycles) opposed to human enamel and stainless steel antagonists. Half of the specimens of each group were loaded with a sliding movement of 0.7mm, the remaining half without. Thereby, 24 different test set-ups were investigated (n=12). Wear of the materials and antagonists was evaluated with a match-3D procedure. The topography of all surfaces was examined with scanning electron microscopy (SEM). Data were statistically evaluated with four-/one-way ANOVA followed by Scheffé post hoc test and unpaired t-test (p<0.05). RESULTS: All PEEK specimens showed significantly less material loss than COMP and PMMA specimens when loaded laterally. Within the axial loaded groups this was only true for the flat specimens tested with enamel antagonists. Crown specimens of these groups exhibited lower loss values than flat ones. Lateral force application led mostly to significantly higher material loss than the axial load application. On the antagonist side, no impact of CAD/CAM polymer material, antagonist material, force application and specimen geometry was found. SIGNIFICANCE: Wear of PEEK was lower than that of the resin-based materials when lateral forces were applied, but showed comparable antagonist wear rates at the same time.

Comparison of four monolithic zirconia materials with conventional ones: Contrast ratio, grain size, four-point flexural strength and two-body wear.

OBJECTIVES: To test the mechanical and optical properties of monolithic zirconia in comparison to conventional zirconia. MATERIALS AND METHODS: Specimens were prepared from: monolithic zirconia: Zenostar (ZS), DD Bio ZX(2) hochtransluzent (DD), Ceramill Zolid (CZ), InCoris TZI (IC) and a conventional zirconia Ceramill ZI (CZI). Contrast ratio (N=75/n=15) was measured according to ISO 2471:2008. Grain sizes (N=75/n=15) were investigated with scanning electron microscope. Four-point flexural strength (N=225/n=15/zirconia and aging regime) was measured initially, after aging in autoclave or chewing simulator (ISO 13356:2008). Two-body wear of polished and glazed/veneered specimens (N=108/n=12) was analyzed in a chewing simulator using human teeth as antagonists. Data were analyzed using 2-/1-way ANOVA with post-hoc Scheffé, Kruskal-Wallis-H, Mann-Whitney-U, Spearman-Rho, Weibull statistics and linear mixed models (p<0.05). RESULTS: The lowest contrast ratio values were found for ZS and IC and CZ. IC showed the largest grain size followed by DD and CZI. The smallest grain size was observed for ZS followed by CZ. There was no correlation between grain size and contrast ratio. The aging regime showed no impact on flexural strength. All non-aged and autoclave-aged specimens showed lower flexural strengths than the control group CZI. Within groups aged in chewing simulator, ZS showed significantly lower flexural strength than CZI. CZI showed higher material and antagonist wear than monolithic polished and glazed groups. Glazed specimens showed higher material and antagonist loss compared to polished ones. There was no correlation between roughness and wear. CONCLUSIONS: Monolithic zirconia showed higher optical, but lower mechanical properties than conventional zirconia.

Complete denture fabrication supported by CAD/CAM.

The inclusion of computer-aided design/computer-aided manufacturing (CAD/CAM) technology into complete denture fabrication facilitates the procedures. The presented workflow for complete denture fabrication combines conventional and digitally supported treatment steps for improving dental care. With the presented technique, the registration of the occlusal plane, the determination of the ideal lip support, and the verification of the maxillomandibular relationship record are considered.

Physicomechanical characterization of polyetheretherketone and current esthetic dental CAD/CAM polymers after aging in different storage media.

STATEMENT OF PROBLEM: Polyetheretherketone (PEEK) can be used to support fixed dental prostheses. However, information about physicomechanical characterization is still scarce. PURPOSE: The purpose of this in vitro study was to assess effects of different aging regimens/durations on roughness, solubility, water absorption, Martens hardness (HM), and indentation modulus/EIT on different computer-aided design and computer-aided manufacturing (CAD/CAM) polymers. MATERIAL AND METHODS: Forty standardized specimens of the following materials were fabricated: PEEK: Dentokeep (DK); hybrid material: VITA Enamic (EN); composite resins: LAVA Ultimate (LU) and an experimental CAD/CAM nanohybrid-composite resin (EX); poly(methyl methacrylate) (PMMA)-based: VITA CAD-Temp (CT); Telio CAD (TC), artBloc Temp (AT), and ZENOTEC ProFix (ZP). A nanofilled-polymer for interim restorations, Protemp 4 (CG), served as the control group. Specimens were stored in sodium chloride, artificial saliva, physiological saliva, and distilled water at 37°C for 1, 7, 14, 28, 90, and 180 days. Roughness, water absorption, HM, and EIT were investigated after each storage period; solubility was determined after 180 days only. Data were analyzed using weighted 3/2/1-way ANOVA and the post hoc Scheffé tests (α=.05). RESULTS: Storage media had no effect on surface roughness and water absorption. Physiological saliva revealed the highest significant impact on solubility followed by artificial saliva, sodium chloride, and distilled water. Water absorption increased significantly with storage duration. PEEK showed the lowest solubility and water absorption values. The highest solubility was observed for the conventional polymer CG, and the highest water absorption was found for the composite LU. PMMA-based TC, ZP, CG, and AT showed the lowest HM and indentation modulus, followed by CT, and PEEK. The highest values were observed for the hybrid material EN, followed by LU and EX. CONCLUSIONS: The hardness parameters of PEEK were comparable with those of PMMA-based materials.

Three-unit reinforced polyetheretherketone composite FDPs: influence of fabrication method on load-bearing capacity and failure types.

To investigate the influence of different fabrication methods of three-unit reinforced polyetheretherketone composite (PEEK/C) fixed dental prostheses (FDPs) on fracture load. Forty-five three-unit anatomically supported PEEK/C FDPs were fabricated as follows: i. milled using a CAD/CAM system from an industrially fabricated PEEK/C blank, ii. pressed from industrially fabricated PEEK/C pellets, and iii. pressed from granular PEEK/C. Fracture load was measured and data were statistically analysed (p<0.05). CAD/CAM fabricated FDPs (2,354 N) presented a higher mean fracture load than those pressed from granular PEEK/C material (1,738 N) (p<0.001). CAD/CAM milled FDPs and those pressed from PEEK/C-pellets showed spontaneous and brittle fractures near the pontic without deformation of the FDP. In contrast, granulate pressed FDPs showed some plastic deformation without fracture. CAD/CAM fabricated FDPs, and FDPs pressed from PEEK/C pellets showed higher Weibull moduli compared to FDPs pressed in granular form. Industrial pre-pressing of blanks (CAD/CAM/pellet) increased the stability and reliability of PEEK restorations.

Influence of abutment model materials on the fracture loads of three-unit fixed dental prostheses.

This study evaluated and compared the influence of different supporting abutment models on the fracture loads of three-unit fixed dental prostheses (FDPs) fabricated from the following materials (n=24/material): (i) IPS e.max CAD-on, (ii) IPS e.max ZirCAD, and (iii) Telio CAD. Twelve FDPs of each group were adhesively cemented on a polymeric model and on a base metal alloy one. For the fracture load test the FDPs were loaded at the centre of the pontic (1 mm/min). The data were analyzed using descriptive statistics, two- and one-way ANOVA followed by post-hoc Scheffé test and Weibull statistics. Fracture loads were found to be affected by the choice of materials used for the abutment models. The fracture load for zirconia FDPs cemented on metal abutments was higher than on polymeric abutment group. In contrast, Telio CAD cemented on polymeric abutments presented higher fracture loads than group on base metal alloy support.

Effects of differing thickness and mechanical properties of cement on the stress levels and distributions in a three-unit zirconia fixed prosthesis by FEA.

PURPOSE: This study analyzed the impact of cement layer thickness (CLT) and Young's modulus of the cement on the stress distribution in a three-unit zirconia fixed dental prosthesis (FDP) and in the bonding interfaces by means of finite element method. MATERIALS AND METHODS: A 3D finite element model was created from a stylized three-unit FDP-cement-tooth/socket system. The pulp and the periodontal ligament were not modeled. Two CLTs (50 and 150 µm) and two values of Young's modulus of the cement (4.9 for simulation of resin cement, 20.1 GPa for glass ionomer cement) were evaluated. A 500 N static vertical load was applied at the central fossa of the pontic to calculate maximum displacement in the framework and maximum principal stresses in both framework and bonding interfaces. RESULTS: The simulated results showed that the Young's modulus affected stress occurrence only in the cement interface. Lower moduli were associated with less stress. The thickness of the cement layer influenced the maximum principal stress in both the FDP and in the cement layer itself. Thicker cement layers led to higher stresses in the framework but lower stresses in the cement layer. Maximum displacement was less dependent of the investigated variables. During all trials, the location of the maximum principal stress did not change. Maximum stress concentrations were observed at the lower embrasures of the connector areas and in the bonding layer at the cervical margin of the preparation. CONCLUSIONS: Choosing cements with a preferably low Young's modulus in combination with a CLT as small as possible might increase the clinical survival rate.

Influence of cementation and cement type on the fracture load testing methodology of anterior crowns made of different materials.

To evaluate the influence of cementation on fracture load of anterior crowns made of CAD/CAM-resin-blocks (ART), leucite-reinforced glass-ceramics (LRG), lithium disilicate ceramics (LIT), veneered zirconia (ZRO) and veneered alloy (DEG). Each crown group (n=15/subgroup) was cemented on the metal abutment as follows: i. using glass ionomer, ii. using self-adhesive resin cement, and iii. not cemented. Crowns were tested and analyzed with 2-way and 1-way ANOVA (Scheffé test), and Weibull statistics (p<0.05). Within LRG, self-adhesive cemented subgroup showed higher fracture load compared to other groups (p<0.001). Among DEG, lower results were measured for non-cemented crowns than for cemented (p<0.001). For ART, LIT and ZRO no influence of cementation was observed. For fracture load test methodology, metal ceramic crowns should be generally cemented. Glass-ceramic crowns should be cemented using adhesive cement. Cementation and cement type did not have an influence on the fracture load results for resin, zirconia or lithium disilicate crowns.

Fracture load of milled polymeric fixed dental prostheses as a function of connector cross-sectional areas.

STATEMENT OF PROBLEM: Polymeric computer-aided design/computer-aided manufacturing (CAD/CAM) blocks exhibit various advantages in contrast to conventionally processed resin restorations. However, the influence of connector dimensions on resin fixed dental prostheses (FDPs) has not yet been investigated. PURPOSE: This study evaluated the impact of connector cross-sectional area (CSA) on the fracture load of 3-unit CAD/CAM FDPs and compared this with conventionally fabricated ones. MATERIAL AND METHODS: Anatomically shaped 3-unit FDPs with the CSAs of 6, 9, 12, and 16 mm(2) (N=240, n=15 per material and per CSA) were fabricated from the following CAD/CAM materials: artBloc Temp (AT), TelioCAD (TC), CAD-Temp (CT), and one conventional resin material, CronMix K (CMK) as the control group. The fracture load was tested and the data were analyzed with 2-way ANOVA, 1-way ANOVA, the Scheffé post hoc test, and Weibull statistics (α=05). RESULTS: CMK showed the significant lowest values for all CSAs followed by CT, except for the 12 mm(2) connector (P<.001). The CAD/CAM FDPs exhibited a significant increase in fracture load with the increase of CSA (P<.001). Conventionally fabricated FDPs presented an increase of values up to the CSA of 12 mm(2). For TC, the shape increased with a larger CSA. The other materials exhibited no tendencies in this regard. Among the 12 mm(2) groups, AT exhibited the highest shape value (19.1), and among the 16 mm(2) groups, TC showed the highest shape value (17.0). The CMK FDPs with a CSA of 16 mm(2) showed almost half as high a shape parameter (6.4) than the other three CSAs. CONCLUSIONS: CAD/CAM resin FDPs revealed significantly higher fracture load values than conventionally fabricated FDPs and showed a significant increase in fracture load with the increase of the CSA.

Load-bearing capacity of soldered and subsequently veneered 4-unit zirconia FDPs.

OBJECTIVES: This study evaluated and compared the impact of soldering on fracture resistance of veneered 4-unit fixed dental prostheses (FDPs). MATERIALS AND METHODS: Forty-eight 4-unit zirconia frameworks were milled and randomly divided in four groups (n=12). Untreated frameworks served as control, one group underwent thermal treatment, one group was sectioned and soldered in the connector between both pontics and one group was sectioned and soldered centrally in the mesial pontic. All frameworks were veneered with glass-ceramic material in powder build-up technique. The fracture load was determined on two different failure types, namely on chipping of the veneering ceramic and on total fracture of the FDP. Data were analysed using descriptive statistics, one-way ANOVA together with the Scheffé post-hoc test and Weibull statistics (p<0.05). RESULTS: The mean range of fracture load of chipped FDPs was determined between 655 N and 789 N; no differences between the tested groups were found (p=0.587). The mean fracture load until total fracture ranged in all tested groups from 768 N to 1261 N. Sound FDPs and soldered FDPs in the connector area presented lower mean total fracture load compared to soldered FDPs in the pontic (p<0.001). CONCLUSIONS: Soldered zirconia frameworks showed similar in-vitro performance compared to sound frameworks.

Polyetheretherketone-a suitable material for fixed dental prostheses?

OBJECTIVES: To study the surface properties of polyetheretherketone (PEEK) and its bond strength with two veneering resins after different conditioning methods as well as fracture load of PEEK three-unit fixed dental prostheses (FDPs). METHODS: Two hundred and twenty five PEEK specimens were fabricated and divided into five groups: no treatment (A), etching with 98% sulfuric acid for 1 min (B), air-abrasion for 10 s with either 50 or 110 µm alumina (C and D, respectively), and silica coating using the Rocatec System (E). On 15 specimens of each conditioning method, contact angle and surface roughness were determined. The remaining 150 specimens of each conditioning method were divided into two groups for the veneering procedure with the composites Gradia (GC Europe) and Sinfony (3M ESPE). Shear bond strength (SBS) was measured and failure types were assessed. In addition, 15 FDPs were milled and the fracture load was tested. Data were analyzed using descriptive statistics, one-way ANOVA (Scheffé test), two sample Student's t-test, and Weibull statistics (p < 0.05). RESULTS: Silica-coated PEEK surfaces showed the highest wettability. The highest roughness and lowest contact angles were observed for 110 µm air-abraded and silica-coated PEEK surfaces. The highest SBS values were, however, achieved in the acid-etched group. PEEK three-unit FDPs showed a mean fracture load of 1383 N with a plastic deformation starting approximately at 1200 N. CONCLUSIONS: Acid etching should be applied when PEEK is used as substructure material and composite veneering material is applied. In this combination, PEEK might be a suitable material for FDPs, especially in load-bearing areas.