Comparison of loupes versus microscope-enhanced CAD-CAM crown preparations: A microcomputed tomography analysis of marginal gaps.

STATEMENT OF PROBLEM: Long-term restoration success depends on a precision marginal fit to prevent marginal leakage and caries. The successful fit of a computer-aided design and computer-aided manufactured (CAD-CAM) crown may be affected by different workflow variables, including preparation, scanning, crown design, milling, sintering, and cementation. Discrepancies in any of these steps may result in poor marginal and internal fit. Evidence suggests that tooth preparation may be the most important step in the workflow for a successful outcome. Compared with the traditional means of crown preparation using the naked eye or loupes, the dental operating microscope provides higher magnification and more direct illumination. However, the impact of high magnification during preparation on the marginal quality of CAD-CAM crowns is unclear. PURPOSE: The purpose of this in vitro study was to compare marginal fits of CAD-CAM crowns fabricated after initial preparation with loupes and subsequent preparation refinement with either loupes or a microscope. The null hypothesis was that no significant difference would be found in the marginal gap between the preparations with loupes and those with a microscope. MATERIAL AND METHODS: Mounted extracted molars (N=18) received initial crown preparations with a coarse grit, rounded shoulder, diamond rotary instrument with loupes of ×3.0 magnification. The teeth were then randomly divided into 2 groups and refined for an additional 2 minutes with fine grit, rounded shoulder, diamond rotary instruments with either loupes (LOUP) or a microscope up to ×10.0 magnification (DOM). The prepared teeth were scanned with an intraoral scanner to fabricate zirconia-reinforced lithium silicate crowns manufactured with a 4-axis milling machine, sintered in a dental furnace in accordance with the manufacturer's instructions, and cemented with self-adhesive resin cement. All teeth with crowns were mounted and scanned with a microcomputed tomography (µCT) system at 21-µm nominal voxel size. The resulting Digital Imaging and Communications in Medicine (DICOM) images were imported into a semiautomatic segmentation software program. Marginal and absolute gaps were measured at 24 consistent circumferential points per specimen. Absolute gaps were labeled, and the total volume was calculated. Paired and unpaired t tests were used for statistical analysis (α=.05). RESULTS: The mean marginal gap was 145.0 ±259.6 µm for LOUP and 35.6 ±110.6 µm for DOM, with a statistically significant difference (P<.001). The mean gap volume for LOUP was 0.975 ±0.811 mm3, and 0.250 ±0.477 mm3 for DOM, also statistically significantly different (P=.023). A significant difference was found between the absolute and marginal gaps for LOUP (P=.007), but for DOM, the difference was not significant (P=.063). CONCLUSIONS: This study demonstrated that the higher magnification used during tooth preparation played a significant role in the size of marginal gaps present around CAD-CAM crowns. Crown preparations finished by using fine grit diamond rotary instruments with a microscope at higher magnification than loupes resulted in a more precise marginal fit with smaller gaps.

2021 Trends in Restorative Dentistry: Composites, Curing Lights, and Matrix Bands.

Composite materials remain a mainstay as a restorative option in dentistry. This article reviews some of the most recent updates and projected future trends in dental composites, along with curing lights and matrix systems.

Wear of enamel opposing zirconia and lithium disilicate after adjustment, polishing and glazing.

OBJECTIVES: To compare the wear and opposing enamel wear of adjusted (A); adjusted and polished (AP); and adjusted and glazed (AG) zirconia and lithium disilicate. METHODS: Specimens (n=8) were prepared of lithium disilicate (A, AP, and AG), zirconia (A, AP, and AG), veneering porcelain, and enamel (control). Surface roughness was measured for each ceramic. In vitro wear was conducted in the UAB-chewing simulator (10 N vertical load/2mm slide/20 cycles/min) with lubricant (33% glycerin) for 400,000 cycles. Isolated cusps of extracted molars were used as antagonists. Scans of the cusps and ceramics were taken at baseline and 400,000 cycles with a non-contact profilometer and super-imposed to determine wear. Data were analyzed with ANOVA and Tukey-Kramer post hoc tests (alpha=0.05). RESULTS: A and AP zirconia showed no detectable signs of wear, and the veneering porcelain demonstrated the most wear. All other ceramics showed significantly less volumetric loss than the veneering porcelain, comparable to enamel-enamel wear. Veneering porcelain produced the most opposing enamel wear (2.15 ± 0.58 mm(3)). AP lithium disilicate and zirconia showed the least amount of enamel wear (0.36 ± 0.09 mm(3) and 0.33 ± 0.11 mm(3) respectively). AG lithium disilicate had statistically similar enamel wear as AP lithium disilicate, but A lithium disilicate had more enamel wear. A and AG zirconia had more enamel wear than AP zirconia. No statistically significant difference was seen between the enamel-enamel group and any other group except the veneering porcelain. CONCLUSIONS: Zirconia has less wear than lithium disilicate. Wear of enamel opposing adjusted lithium disilicate and zirconia decreased following polishing. CLINICAL SIGNIFICANCE: Zirconia experiences less and lithium disilicate experiences equivalent occlusal wear as natural enamel. It is preferable to polish zirconia and lithium disilicate after adjustment to make them wear compatible with enamel. Veneering of zirconia and lithium disilicate should be avoided in areas of occlusal contact to prevent enamel wear.

The wear of polished and glazed zirconia against enamel.

STATEMENT OF PROBLEM: The wear of tooth structure opposing anatomically contoured zirconia crowns requires further investigation. PURPOSE: The purpose of this in vitro study was to measure the roughness and wear of polished, glazed, and polished then reglazed zirconia against human enamel antagonists and compare the measurements to those of veneering porcelain and natural enamel. MATERIAL AND METHODS: Zirconia specimens were divided into polished, glazed, and polished then reglazed groups (n=8). A veneering porcelain (Ceramco3) and enamel were used as controls. The surface roughness of all pretest specimens was measured. Wear testing was performed in the newly designed Alabama wear testing device. The mesiobuccal cusps of extracted molars were standardized and used as antagonists. Three-dimensional (3D) scans of the specimens and antagonists were obtained at baseline and after 200 000 and 400 000 cycles with a profilometer. The baseline scans were superimposed on the posttesting scans to determine volumetric wear. Data were analyzed with a 1-way ANOVA and Tukey Honestly Significant Difference (HSD) post hoc tests (α=.05) RESULTS: Surface roughness ranked in order of least rough to roughest was: polished zirconia, glazed zirconia, polished then reglazed zirconia, veneering porcelain, and enamel. For ceramic, there was no measureable loss on polished zirconia, moderate loss on the surface of enamel, and significant loss on glazed and polished then reglazed zirconia. The highest ceramic wear was exhibited by the veneering ceramic. For enamel antagonists, polished zirconia caused the least wear, and enamel caused moderate wear. Glazed and polished then reglazed zirconia showed significant opposing enamel wear, and veneering porcelain demonstrated the most. CONCLUSIONS: Within the limitations of the study, polished zirconia is wear-friendly to the opposing tooth. Glazed zirconia causes more material and antagonist wear than polished zirconia. The surface roughness of the zirconia aided in predicting the wear of the opposing dentition.