Three-dimensional analysis of the interchangeability of a semiadjustable articulator system in service over time.

STATEMENT OF PROBLEM: Some contemporary articulator systems claim to be highly precise in their interchangeability, with tolerances below 10 µm in vertical error; however, the claims have not been independently verified. PURPOSE: The purpose of this study was to investigate the interchangeability of calibrated semiadjustable articulators in service over time. MATERIAL AND METHODS: A calibrated mounting articulator served as the master articulator, while the test groups were used articulators with a minimum of 1-year use by predoctoral dental students (n=10); used articulators with a minimum of 1-year use by prosthodontic residents (n=10); and new articulators (n=10). One set of mounted maxillary and mandibular master models was positioned in the master and test articulators. High-precision reference markers on the master models were used to determine interarch 3D distance distortions (dRR, dRC, and dRL), interocclusal 3D distance distortion (dRM), interocclusal 2D distance distortions (dxM, dyM, and dzM), and interocclusal angular distortion (dθM) relative to the master articulator. All measurements were conducted three times using a coordinate measuring machine and then averaged to derive the final data set. RESULTS: For interarch 3D distance distortion, the mean dRR ranged from 4.6 ±21.6 µm for new articulators to 56.3 ±47.6 µm for articulators used by prosthodontic residents; mean dRC ranged from 65 ±48.6 µm for new articulators to 119.0 ±58.8 µm for articulators used by prosthodontic residents; and mean dRL ranged from 12.7 ±39.7 µm for articulators used by prosthodontic residents to 62.8 ±75.2 µm for new articulators. For interocclusal 3D distance distortion, the mean dRM ranged from 21.5 ±49.8 µm for new articulators to 68.6 ±64.9 µm for articulators used by predoctoral dental students. For the 2D distance distortions, the mean dxM ranged from -17.9 ±43.4 µm for articulators used by predoctoral dental students to -61.9 ±48.3 µm for articulators used by prosthodontic residents; mean dyM ranged from 18.1 ±59.4 µm for new articulators to 69.3 ±115.1 µm for articulators used by prosthodontic residents; and mean dzM ranged from 29.5 ±20.2 µm for new articulators to 70.1 ±37.8 µm for articulators used by prosthodontic residents. Mean dθM ranged from -0.018 ±0.289 degree for new articulators to 0.141 ±0.267 degree for articulators used by prosthodontic residents. One-way ANOVA by articulator type revealed statistically significant differences among the test groups for dRR (P=.007) and dzM (P=.011) only, where articulators used by prosthodontic residents fared significantly poorer than the other test groups. CONCLUSIONS: The new and used articulators tested did not fulfill the manufacturer's claim of accuracy of up to 10 µm in the vertical dimension. Up to 1 year of time in service, none of the investigated test groups fulfilled the criterion for articulator interchangeability, even if the more lenient threshold of 166 µm were accepted.

Rotational Load Fatigue Performance of Titanium vs Titanium-Zirconium Implant-Abutment Connections.

PURPOSE: Titanium-zirconium (Ti-Zr) alloy has been developed to strengthen the implant body, but clinically relevant information is still limited. The aim of this in vitro study was to compare the rotational load fatigue performance of implant-abutment connections in narrow-diameter (3.3-mm) and regular-diameter (4.1-mm) implants made with commercially pure grade 4 titanium alloy (CPTi-G4) and Ti-Zr. MATERIALS AND METHODS: Narrow-diameter (N) and regular-diameter (R) implants with CPTi-G4 (Ti) or Ti-Zr (Tz) materials were tested. This resulted in four test groups: NTi, NTz, RTi and RTz. Five specimens were made for each group (n = 5). Abutments used were milled from titanium-aluminum-niobium alloy abutment blanks. A rotational load fatigue machine applied a sinusoidally varying load at an angle of 45 degrees to produce an effective bending moment of 35 Ncm at a frequency of 14 Hz in air at 20°C. The number of cycles to failure was recorded. The upper limit was set as 5 million cycles. Results were evaluated using analysis of variance (ANOVA) and Tukey post hoc tests. Failure locations and patterns were evaluated with scanning electron microscope (SEM). RESULTS: All regular-diameter test groups reached the upper limit of 5 million cycles without failure. All narrow-diameter test groups failed within the range of 402,530 cycles to 3,374,353 cycles. It could be observed that NTz showed a higher mean cycle count as compared to NTi. NTi test group recorded two implants damaged, one implant fracture, five abutment fractures, and four screw fractures. NTz test group showed only abutment fractures at the level of implant platform, with no damage to the implant bodies. Significant difference was found between implants of different diameters. There was no significant difference between implants of different materials. CONCLUSION: Regular-diameter implants performed significantly better than narrow-diameter implants, regardless of material, while no significant difference in cyclic load to failure was found between groups of different alloys. All NTz failures were at the abutment only, without damage to the implant. This failure pattern can potentially be clinically advantageous in terms of retrieval and subsequent replacement of a failed prosthesis.

Comparison of Three-Dimensional Accuracy of Digital and Conventional Implant Impressions: Effect of Interimplant Distance in an Edentulous Arch.

PURPOSE: This study compared the three-dimensional (3D) accuracy of conventional impressions with digital impression systems (intraoral scanners and dental laboratory scanners) for two different interimplant distances in maxillary edentulous arches. MATERIALS AND METHODS: Six impression systems comprising one conventional impression material(Impregum), two intraoral scanners (TRIOS and True Definition), and three dental laboratory scanners (Ceramill Map400, inEos X5, and D900) were evaluated on two completely edentulous maxillary arch master models (A and B) with six and eight implants, respectively. Centroid positions at the implant platform level were derived using either physical or virtual probe hits with a coordinate measuring machine. Comparison of centroid positions between master and test models (n = 5) defined linear distortions (dx, dy, dz), global linear distortions (dR), and 3D reference distance distortions between implants (ΔR). The two-dimensional (2D) angles between the central axis of each implant to the x- or y-axes were compared to derive absolute angular distortions (Absdθx, Absdθy). RESULTS: Model A mean dR ranged from 8.7 ± 8.3 µm to 731.7 ± 62.3 µm. Model B mean dR ranged from 16.3 ± 9 µm to 620.2 ± 63.2 µm. Model A mean Absdθx ranged from 0.021 ± 0.205 degrees to -2.349 ± 0.166 degrees, and mean Absdθy ranged from -0.002 ± 0.160 degrees to -0.932 ± 0.290 degrees. Model B mean Absdθx ranged from -0.007 ± 0.076 degrees to -0.688 ± 0.574 degrees, and mean Absdθy ranged from -0.018 ± 0.048 degrees to -1.052 ± 0.297 degrees. One-way analysis of variance (ANOVA) by Impression system revealed significant differences among test groups for dR and ΔR in both models, with True Definition exhibiting the poorest accuracy. Independent samples t tests for dR, between homologous implant location pairs in Model A versus B, revealed the presence of two to four significant pairings (out of seven possible) for the intraoral scanner systems, in which instances dR was larger in Model A by 110 to 150 µm. CONCLUSION: Reducing interimplant distance may decrease global linear distortions (dR) for intraoral scanner systems, but had no effect on Impregum and the dental laboratory scanner systems. Impregum consistently exhibited the best or second-best accuracy at all implant locations, while True Definition exhibited the poorest accuracy for all linear distortions in both Models A and B. Impression systems could not be consistently ranked for absolute angular distortions.

Three-Dimensional Static Articulation Accuracy of Virtual Models-Part II: Effect of Model Scanner-CAD Systems and Articulation Method.

PURPOSE: Accurate maxillomandibular relationship transfer is important for CAD/CAM prostheses. This study compared the 3D-accuracy of virtual model static articulation in three laboratory scanner-CAD systems (Ceramill Map400 [AG], inEos X5 [SIR], Scanner S600 Arti [ZKN]) using two virtual articulation methods: mounted models (MO), interocclusal record (IR). MATERIALS AND METHODS: The master model simulated a single crown opposing a 3-unit fixed partial denture. Reference values were obtained by measuring interarch and interocclusal reference features with a coordinate measuring machine (CMM). MO group stone casts were articulator-mounted with acrylic resin bite registrations while IR group casts were hand-articulated with poly(vinyl siloxane) bite registrations. Five test model sets were scanned and articulated virtually with each system (6 test groups, 15 data sets). STL files of the virtual models were measured with CMM software. dRR , dRC , and dRL , represented interarch global distortions at right, central, and left sides, respectively, while dRM , dXM , dYM , and dZM represented interocclusal global and linear distortions between preparations. RESULTS: Mean interarch 3D distortion ranged from -348.7 to 192.2 µm for dRR , -86.3 to 44.1 µm for dRC , and -168.1 to 4.4 µm for dRL . Mean interocclusal distortion ranged from -257.2 to -85.2 µm for dRM , -285.7 to 183.9 µm for dXM , -100.5 to 114.8 µm for dYM , and -269.1 to -50.6 µm for dZM . ANOVA showed that articulation method had significant effect on dRR and dXM , while system had a significant effect on dRR , dRC , dRL , dRM , and dZM . There were significant differences between 6 test groups for dRR, dRL dXM , and dZM . dRR and dXM were significantly greater in AG-IR, and this was significantly different from SIR-IR, ZKN-IR, and all MO groups. CONCLUSIONS: Interarch and interocclusal distances increased in MO groups, while they decreased in IR groups. AG-IR had the greatest interarch distortion as well as interocclusal superior-inferior distortion. The other groups performed similarly to each other, and the overall interarch distortion did not exceed 0.7%. In these systems and articulation methods, interocclusal distortions may result in hyper- or infra-occluded prostheses.

Three-Dimensional Static Articulation Accuracy of Virtual Models - Part I: System Trueness and Precision.

PURPOSE: To evaluate the 3D static articulation accuracy of 3 model scanner-CAD systems (Ceramill Map400 [AG], inEos X5 [SIR], Scanner S600 Arti [ZKN]) using a coordinate measuring machine (CMM). Trueness and precision for each system will be reported in Part I. MATERIALS AND METHODS: The master model simulated a single crown opposing a 3-unit fixed dental prosthesis. Five mounted stone cast sets were prepared, and one set was randomly selected. Reference values were obtained by measuring interarch and interocclusal reference features with the CMM. The stone cast set was scanned 5 times consecutively and articulated virtually with each system (3 test groups, n = 5). STL files of the virtual models were measured with CMM software. dRR , dRC , and dRL , represented interarch global distortions at right, central, and left sides, respectively, while dRM , dXM , dYM , and dZM represented interocclusal global and linear distortions between preparations. RESULTS: For trueness values, mean interarch global distortions ranged from 13.1 to 40.3 µm for dRR , -199.0 to -48.1 µm for dRC , and -114.1 to -47.7 µm for dRL . Mean percentage error of interarch distortion did not exceed 0.6%. Mean interocclusal distortions ranged from 16.0 to 117.0 µm for dRM , -33.1 to 101.3 µm for dXM , 32.9 to 49.9 µm for dYM and -32.0 to 133.1 µm for dZM. ANOVA of trueness found statistically significant differences for dRC , dRL , dRM , dXM , and dZM . For precision values, absolute mean difference between the 10 superimposition combinations ranged from 25.3 to 91.0 µm for dRR , 21.5 to 85.5 µm for dRC , 24.8 to 70.0 µm for dRL . Absolute mean difference ranged from 49.9 to 66.1 µm for dRM , 20.7 to 92.1 µm for dXM , 86.8 to 96.0 µm for dYM , and 36.5 to 100.0 µm for dZM . ANOVA of precision of all test groups found statistically significant differences for dRR , dRC , dRL , dXM and dZM , and the SIR group was the least precise. CONCLUSION: The overall interarch global distortion of all three model scanner-CAD systems was low and did not exceed 0.6%. Variations in scanner technology, virtual articulation algorithm, and use of physical articulators contributed to the differences in distortion observed among all three groups.