Marginal and internal adaptation of ceramic crown restorations fabricated with CAD/CAM technology and the heat-press technique

Abstract

The accuracy of chairside computer-aided design and computer-aided manufacturing (CAD/CAM) restorations is questionable, and the effect of the die spacer settings is not well stated in the literature. The purpose of the study was to evaluate the marginal and internal adaptation of E4D crowns fabricated with different spacer thicknesses and to compare these crowns with those fabricated with the heat-press technique. The E4D system was used to fabricate 30 crowns for the first 3 groups, with different spacer thickness settings: 30 μm, 60 μm, and 100 μm. In the fourth group, 10 lithium disilicate crowns were fabricated with the heat-press technique. The occlusal gap, axial gap, vertical marginal gap, and absolute marginal discrepancy were evaluated by x-ray microtomography. Statistical significance was assessed with the Kruskal-Wallis test (α=.05). For post hoc analyses, the Mann-Whitney U test was used alongside the Bonferroni correction for multiple comparisons (α=.008). Within the CAD/CAM groups, the 30-μm spacer thickness resulted in the lowest median axial gap (90.04 μm), whereas the 60-μm spacer thickness resulted in the lowest median occlusal gap (152.39 μm). The median marginal gap values of the CAD/CAM-60 group (49.35 μm) and CAD/CAM-100 group (46.65 μm) were lower than those of the CAD/CAM-30 group (55.18 μm). No significant differences among the CAD/CAM groups were observed for absolute marginal discrepancy. The heat-press group had significantly different values than those of the CAD/CAM groups. The spacer thickness and fabrication technique affected the adaptation of ceramic crowns. The heat-press group yielded the best marginal and internal crown adaptation results. The 30- or 60-μm spacer settings are recommended for the E4D CAD/CAM system.