Abstract
Background: Due to their increased precision, CAD/CAM generated bars (Computer-Aided Design/ Computer-Aided Manufacturing) are increasingly utilized in implant prosthodontics. For optimal clinical results, surface morphology should promote the integration of soft tissue while minimizing plaque and bacterial retention. Objective: Despite their clinical use, only limited information on the biological and clinical surface quality of CAD/CAM milled bars is available. The aim of the study was therefore to characterize the surface topography of bars of different manufacturers based on the profilometric analysis and the need for manual post-processing in the laboratory. Methods: A custom mandibular edentulous cast with four anterior implants was used as a reference cast and reproduced eight times. On each reproduction cast, corresponding scan flags were positioned and digitized. Acrylic 3D printed bar frameworks were produced and sent to the respective production center along with the digital files of the CAD bars for milling. In the course of profilometric analysis, all bars were examined in three critical Regions of Interest (ROI): Transmucosal, labial, basal. Sa and Ra values of each construction were determined. To evaluate the necessary refinishing time eight dental technicians macroscopically evaluated the bars by performing a subjective visual inspection. Kruskal-Wallis H-tests and Tukey and Kramer's post hoc tests were applied to detect differences between the samples. Results: After profilometric examination, three specimens (Dentsply Sirona: ZDC; Straumann: ZST; CAMLOG: ZCC) demonstrated surface roughness values in the biological acceptable range (Sa 0.2-0.4 μm) in the transmucosal region and provided optimal conditions for a reliable soft tissue adaptation. The Ra measurements revealed values beyond the acceptable threshold in the transmucosal region for three bars (Straumann: ZST; Dentsply Sirona: ZDC; Amann Girrbach: LAC). Four bars (LAC: Amann Girrbach; ZBC: BEGO; Datron: LDC & LDT; Zirkonzahn: ZZC) needed undesirable extensive manual rework. The evaluation of quality and time for manual post-processing by dental technicians confirmed the measurement-based ranking of the bars. Conclusion: It is desirable to define a clear roughness threshold for the clinical acceptance of transmucosal CAD/CAM generated surfaces. Clinical studies with profilometric data could help to further improve the surface quality of CAD/CAM milled bars and reduce the need for manual reworking time and effort.
Highlights
In addition to conventional, mucosa-supported prostheses, removable implant-supported solutions form part of the standard restorations of the edentulous jaw
The null hypothesis was that the Computer-Aided Design and Computer-Aided Manufacturing (CAD/computer-aided manufacturing (CAM))-based milling processes of implant-supported bars from different manufacturers result in a biologically acceptable surface roughness of Ra=0.2 μm without statistically significant differences in Ra- and Sa -values, and require no further manual reworking in the laboratory
The results of the present study show that bars which were milled by implant manufacturers at central locations have a clinically adequate surface morphology and require only a little or no rework at all
Summary
Mucosa-supported prostheses, removable implant-supported solutions form part of the standard restorations of the edentulous jaw. The null hypothesis was that the CAD/CAM-based milling processes of implant-supported bars from different manufacturers result in a biologically acceptable surface roughness of Ra=0.2 μm without statistically significant differences in Ra- and Sa -values, and require no further manual reworking in the laboratory. Due to their increased precision, CAD/CAM generated bars (Computer-Aided Design/ Computer-Aided Manufacturing) are increasingly utilized in implant prosthodontics. Surface morphology should promote the integration of soft tissue while minimizing plaque and bacterial retention
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