Evaluation of marginal and internal fit of single crowns manufactured with an analog workflow and three CAD-CAM systems: A prospective clinical study.

PURPOSE: This prospective clinical study evaluated and compared the marginal and internal fit of crowns fabricated with an analog workflow and three different computer-aided design and computer-aided manufacturing (CAD-CAM) systems. MATERIALS AND METHODS: Twenty-five participants in need of a single complete-coverage molar or premolar crown were recruited in the study. Twenty-two completed the study, and three participants dropped out. Teeth were prepared according to a standardized protocol by one operator. For each participant, one final impression was made with polyether material (PP) and three intraoral scanners: CEREC Omnicam (C), Planmeca Planscan (PM), and True Definition (TR). For the PP group, crowns were fabricated with a pressable lithium disilicate ceramic, whereas for the other three groups (C, PM, and TR), crowns were designed and milled with dedicated CAD-CAM systems and materials. Marginal (vertical and horizontal) and internal discrepancies between the crowns and tooth preparation were measured at various locations with digital superimposition software. Data was analyzed for normality with Kolmogorov-Smirnov and Shapiro-Wilk tests and then compared with one-way ANOVA and Kruskal-Wallis tests. RESULTS: Mean vertical marginal gap values were 92.18 ± 141.41 µm (PP), 150.12 ± 138.06 µm (C), 129.07 ± 109.96 µm (PM), and 135.09 ± 112.03 µm (TR). PP group had statistically significantly smaller vertical marginal discrepancy (p = 0.001) than all other groups, whereas no significant difference was detected among the three CAD-CAM systems (C, PM, and TR). Horizontal marginal discrepancies were 104.93 ± 111.96 µm (PP), 89.49 ± 119.66 µm (C), 113.36 ± 128.49 µm (PM), and 136.39 ± 142.52 µm (TR). A significant difference was detected only between C and TR (p < 0.0001). Values for the internal fit were 128.40 ± 49.31µm (PP), 190.70 ± 69.79µm (C), 146.30 ± 57.70 µm (PM), and 168.20 ± 86.67 µm (TR). The PP group had a statistically significant smaller internal discrepancy than C (p < 0.0001) and TR groups (p = 0.001), whereas no significant difference was found compared to the PM group. CONCLUSION: Posterior crowns fabricated with CAD-CAM systems showed vertical margin discrepancy greater than 120 µm. Only crowns fabricated with the conventional methodology had vertical margins below 100 µm. Horizontal marginal discrepancy was different among all groups, and only CEREC CAD-CAM was below 100 µm. Internal discrepancy was less for crowns fabricated with an analog workflow.

Comprehensive digital approach with the Digital Smile System: A clinical report.

This clinical report describes a comprehensive digital approach with the Digital Smile System (DSS) and its clinical use in the prosthetic treatment of a patient for whom 6 anterior maxillary porcelain veneers were fabricated. Following this digital protocol, extraoral facial images and a diagnostic intraoral digital scan were obtained. Digital smile analysis, virtual diagnostic waxing, and milled trial restorations were made in the diagnostic phase. After tooth preparation, data from digital scans were used in the computer-aided design and computer-aided manufacturing (CAD-CAM) of the definitive restorations.