3-unit Fixed Partial Dentures Research Articles

Difference in marginal bone loss around implants between short implant-supported partial fixed prostheses with and without cantilever: a retrospective clinical study

PurposeTo investigate the influence of cantilever prosthetic arm on the marginal bone loss (MBL) over time around dental implants supporting short fixed partial dentures (FPDs), in a record-based retrospective study.MethodsAll cases of 3-unit implant-supported FPDs, supported by 2–3 implants, from the database of cases treated at one specialist clinic were considered for inclusion. Only implants with a minimum of 36 months of radiological follow-up were considered. Univariate linear regression models were used to compare MBL over time between 12 clinical covariates, after which a linear mixed-effects model was built.ResultsOne-hundred-thirty-nine patients (64 men, 75 women) with 164 3-unit implant-supported FPDs (333 implants supporting non-cantilevered FPDs, 94 supporting cantilevered FPDs) were included in the study. The patients were followed up clinically and radiographically for a mean of 154.1 ± 78.0 (min–max, 37.3–364.6) and 132.9 ± 77.3 months (min–max, 36.8–329.9), respectively. The total number of marginal bone level double measurements (mesial and distal sides of each implant) was 2909. FPDs with cantilever presented an estimated greater MBL over time compared to FPDs without cantilever. Bruxism, sex (women), implant (modified) surface, and (poor) bone quality were also associated with higher MBL over time.ConclusionsThe use of a cantilever extension is suggested to negatively affect the bone marginal level over time around implants supporting 3-unit FPDs. Due to the small difference of the estimated MBL over long periods of follow-up between the groups, it is a matter of debate if the observed negative effect may be of clinical significance.Graphical

Evaluation of two implant-supported fixed partial denture abutment designs: influence on screw surface characteristics.

To compare screw surface characteristics between hemi-engaging and non-engaging implant-supported fixed partial denture (FPD) designs after cyclic loading. Twenty-four implants measuring 4.3 × 10mm were mounted on acrylic resin blocks. Specimens were divided into 2 groups. An experimental group included twelve 3-unit FPD with a hemi-engaging design; a control group included twelve 3-unit FPD with the conventional design of two non-engaging abutments. Both groups were subjected to two types of cycling loading (CL), first axial loading, and then lateral loading at 30°. Load was applied to the units one million times (1.0×106 cycles) for each loading axis. Data on screw surface roughness in three locations and screw thread depth were collected before (BL) and after (AL) each loading type. Screw surface roughness was measured in μm using a mechanical digital surface profilometer and optical profiler. To evaluate screw thread depth in μm, an upright optical microscope Axio-imager 2 was used. To confirm readings made from the optical microscope, four random samples were selected from each group for scanning electron microscopy (SEM) analysis. The effect of cyclic loading was evaluated by averaging values across the two screws within each specimen, then calculating difference scores (DL) between BL and AL (DL = AL - BL). Additional difference scores were computed between the non-engaging screws in each experimental group specimen, and one randomly selected non-engaging screw in each control specimen. This difference was referred to as the non-engaging DL. Statistical significance was assessed using Mann-Whitney U tests (α = .05). Comparisons of DL and non-engaging DL by loading type revealed one significant difference regarding surface roughness at the screw thread. Significantly greater mean changes were observed after axial loading compared to lateral loading regarding both DL (axial M = -0.36 ± 0.08; lateral M = -0.21 ± 0.09; U = 20; p = .003) and non-engaging DL (axial M = -0.40 ± 0.22; lateral M = -0.21 ± 0.11; U = 29; p = .013). No significant differences in screw surface roughness in other sites or thread depth were found between the experimental and control abutment designs in DL or in non-engaging DL. No significant differences were found for DL (axial U = 13, P = .423; lateral U = 9, P = .150;) or non-engaging DL (axial U = 13, P = .423; lateral U = 18, P = 1.00). Results suggest that overall, changes in screw surface physical characteristics did not differ between hemi-engaging and non-engaging designs after evaluating screw surface roughness and thread depth before and after axial and lateral cyclic loading. This article is protected by copyright. All rights reserved.

Fracture resistance of 3-unit monolithic ZrO2 ceramics FPDs with different preparation designs of the distal abutment - an in-vitro study

Masticatory pressure increases in the distal areas of the dentition. This should be considered when restoring partially edentulous patients with a metal-free fixed partial denture (FPD). An alternative abutment preparation design can be used in order to increase the materials' volume in the most fracture-prone "connector area" of an FPD. The increased size of the connection might positively influence the constructions' mechanical durability, thereby increasing its success and survivability. The aim of the present study was to investigate the influence of two preparation designs of the distal abutment on the fracture resistance of three-unit, monolithic, ZrO2 FPDs. 3D printed replicas of a partially edentulous mandibular segment and a ZrO2, milled in full-contour, three-unit FPDs were used for this investigation. Two experimental groups (n=10 ) were defined based on the preparation design of the distal abutment tooth - classical shoulder preparation 0.8mm deep, and endocrown preparation with a 2-mm retention cavity. The bridge - mandibular segment replica assembly was done with relyXU200(3M ESPE, USA), light-cured for 10 seconds per side with D-light Duo (GC, Europe). After cementation the test specimens were subjected to loading in a universal testing machine Zwick (Zwick-Roell Group, Germany). Statistical analysis was performed using R and includes descriptive statistics, t-test for quantitative and chi-squared test for qualitative variables. The results showed no difference between the two studied groups in the maximum force required to fracture the test specimens [t=-1.8088 (17.39), p-value=0.087; P>0.05]. 95% of the fracture lines were located in the distal connector. Within the limitations of this study, it can be concluded that both tested preparation designs show similar results in terms of the load required to fracture the test specimens. Furthermore, it is confirmed that the distal connector is the weakest area of an all-ceramic 3-unit FPD in the posterior area.

Cytokine expression in gingival crevicular fluid around teeth opposing dental implants and 3-unit fixed partial dentures in a cross-sectional study

ObjectiveThis study aimed to study the cytokines in gingival crevicular fluid (GCF) of the teeth opposing to dental implants and 3-unit fixed partial dentures (FPDs).Materials and methodsA total of 74 participants were recruited for this cross-sectional study. Based on the status of lower first molars, the participants were divided into dental implants group and 3-unit FPDs group. Social index and oral hygiene were recorded. Occlusal loading was evaluated with a T-scan. GCF was sampled from the upper first molar and assessed with a commercial cytokine assay kit.ResultsForty three dental implants patients and 31 3-unit FPDs patients received all of the clinical and laboratory evaluation. The dental implants group had a higher occlusion force distribution on first molars region. IL-10, IL-17, RANK had a higher mean in dental implants group and was associated with occlusion force of first molar. There was a weakly association between IL-10 and dental implants in the binary logistic regression analyses.ConclusionsIn this study, the teeth opposing implants have a higher level of cytokines in the GCF than teeth opposing to 3-unit FPDs in periodontal healthy participants because of the poor osseoperception of dental implants. IL-10 might reflect a higher occlusion force in dental implants region.Clinical relevanceThis study provided that different tooth restoration methods could influence the periodontal status of the contact teeth.

Fracture strength and energy-dispersive spectroscopy analysis of 3-unit fixed partial dentures fabricated from different monolithic zirconia materials

Statement of problemMastication forces in different regions affect the survival of multiunit posterior restorations. The fracture strength of 3-unit posterior monolithic zirconia fixed partial dentures (FPDs) and their fracture patterns require investigation. PurposeThe purpose of this in vitro study was to evaluate and compare the fracture strength and fracture pattern of 3-unit posterior FPDs fabricated from different monolithic zirconia materials. Material and methodsThirty 3-unit FPDs were fabricated from BruxZir, FireZr, and Upcera (n=10 per group). Energy-dispersive spectroscopy analysis was performed on 2 selected specimens from each group. All specimens were exposed to a mastication simulator for 1.2×106 cycles and then monotonically loaded to fracture at a crosshead speed of 1 mm/min. The surfaces of a selected fractured specimen were examined at magnifications of ×25 and ×500 with scanning electron microscopy. Conformity to normal distribution was evaluated with the Shapiro-Wilk test. One-way analysis of variance was used to compare the normally distributed initial crack formation load F initial (Fi) and catastrophic failure strength F maximum (Fm) means by group. Weibull statistics were calculated by using the maximum likelihood estimation method. The chi-square test was used to compare shape and scale parameters (α=.05). ResultsThe mean Fm values were fail1878.9 N for Upcera, 2177.8 N for BruxZir, and 2229.4 N for FireZr. Upcera and BruxZir showed statistically significant differences for the Fm mean values (P=.039). The differences between the fracture type distributions according to the groups were statistically similar (P>.05). For Fi, Upcera presented the highest Weibull modulus value (2.199), FireZr had the lowest (1.594), while for Fm, BruxZir had the highest Weibull modulus value (9.267) and FireZr the lowest (6.572). ConclusionsUsing the zirconia materials BruxZir, FireZr, and Upcera resulted in high Fm values after aging procedures. With all materials, the fractures were most commonly found in the connector areas in the tested FPDs.

Comparison of the color stability and surface roughness of 3-unit provisional fixed partial dentures fabricated by milling, conventional and different 3D printing fabrication techniques

ObjectivesTo compare the color stability and surface roughness of 3-unit provisional fixed partial dentures (FPDs) fabricated by milling, conventional, and different 3D printing fabrication techniques. MethodsA total sample of 160, 3-unit FPDs were subdivided into four groups; subtractive milled resin (SM), two 3D printed resins (Stereolithography; SLA and Digital Light Processing; DLP) and conventional self-cured polymethyl methacrylate resin (CM). Surface roughness (Ra) was assessed twice; at baseline (Ra1) and after artificial tooth brushing (Ra2). Color of the samples was measured after immersion in four different solutions (cola, coffee, black tea and distilled water) at three time intervals (1, 7 and 30 days). Comparisons of the Ra and the color change (∆E00) were done using one-way ANOVA followed by multiple pairwise comparisons using Bonferroni adjusted significance level. Comparisons of the Ra at two stages (Ra1 and Ra2) were done using paired t-test. Univariate linear regression was performed followed by multivariable regression to assess the association between ∆E00 and different factors (materials, solution, and time). Significance was set at P value <0.05. ResultsThe highest change in Ra following artificial tooth brushing was reported in the CM group, while the lowest change was reported in the SM group, with a significant difference between both groups (P<0.001). SM group had significantly lower ∆E00 than the CM group followed by 3D printed SLA and DLP groups (P<0.001). Storage in coffee for 30 days showed the highest ∆E00 values (P<0.001). ConclusionsSM resin showed the least surface roughness and color change followed by 3D printed SLA resin. The difference in printing technology affected the tested properties with improved readings of 3D printed SLA resin. Clinical significanceMilled provisional FPDs showed higher surface smoothness and color stability than those fabricated by SLA printing technology, but with no significant difference between both groups. Therefore, SLA printed resins can be an adequate substitute to milled resins in the fabrication of provisional FPDs to overcome the high expenses of milled provisional FPDs.

Effect of intraoral scanner and fixed partial denture situation on the scan accuracy of multiple implants: An in vitro study.

Accuracy of intraoral implant scans may be affected by the region of the implant and the type of the intraoral scanner (IOSs). However, there is limited knowledge on the scan accuracy of multiple implants placed for an implant-supported fixed partial denture (FPD) in different partially edentulous situations when digitized by using different IOSs. To investigate the effect of IOS and FPD situation on the scan accuracy of two implants when partial-arch scans were performed. Tissue level implants were placed in 3 maxillary models with implant spaces either at right first premolar and right first molar sites (Model 1, 3-unit FPD), at right canine and right first molar sites (Model 2, 4-unit FPD), or at lateral incisor sites (Model 3, 4-unit FPD). Reference standard tessellation language (STL) files of the models were generated by using an optical scanner (ATOS Capsule 200MV120). Two IOSs (CEREC Primescan [CP] and TRIOS 3 [TR]) were used to perform partial-arch scans (test-scans) of each model (n=14), which were exported in STL format. A metrology-grade analysis software (GOM Inspect 2018) was used to superimpose test-scan STLs over the reference STL to calculate 3D distance, inter-implant distance, and angular (mesiodistal and buccopalatal) deviations. Trueness and precision analyses were performed by using bootstrap analysis of variance followed by Welch tests with Holm correction (α=0.05). Trueness of the scans was affected by IOS and FPD situation when 3D distance deviations were considered, while inter-implant distance, mesiodistal angular, and buccopalatal angular deviations were only affected by the FPD situation (p < 0.001). Scan precision was affected by the interaction between the IOSs and the FPD situation when 3D distance and buccopalatal angular deviations were concerned, while IOSs and FPD situation were effective when all deviations were concerned (p≤ 0.001). When 3D distance deviations were considered, CP scans had higher accuracy TR scans in Models 1 and 3 (p ≤ 0.002), and the Model 1 scans had the highest accuracy (p < 0.001). When inter-implant distance deviations were considered, Model 1 scans had the highest accuracy with CP and higher accuracy than Model 2 when TR was used (p ≤ 0.030). When mesiodistal angular deviations were considered, Model 1 scans had the highest accuracy (p ≤ 0.040). When buccopalatal angular deviations were considered, Model 1 scans had the highest accuracy among models when CP was used (p ≤ 0.020). Posterior 3-unit fixed partial denture implant scans, CP scans, and combination of these two factors had accuracy either similar to or better than their tested counterparts.

Fatigue Resistance of 3-Unit CAD-CAM Ceramic Fixed Partial Dentures: An FEA Study.

To estimate the fatigue life of 3-unit molar fixed partial dentures (FPDs) made from two different monolithic ceramic systems, zirconia cercon (ZC) and lithium disilicate (LD). The effect of the connector size on the fatigue resistance of the monolithic FPD was also investigated. Two models for the FPDs were built, a 3-unit all-ceramic and a porcelain-fused-to-metal. The porcelain-fused-to-metal FPD model was used as the control. Actual 3-unit FPDs (replacing the second lower premolar) were constructed using a computer aided design and computer-aided manufacturing (CAD-CAM) system. Finite element analysis (FEA) was executed. A hemispherical indenter was used to simulate occlusal load. The occlusal load phase of the chewing cycle was applied at the premolar pontic. The failure location for the monolithic FPD was always located at the distal connector. Connector size played a key role in determining the long-term survival of the prosthesis. The fatigue resistance was predicted to be 670 N for the ZC with a connector size 4 × 3 mm, while it was only 226 N for LD. As for porcelain-fused-to-metal (PFM), FEA predicts that fatigue resistance can reach up to 770 N. Under the cyclic load of 670 N, the fatigue life for the zirconia FPD with connector size 4 × 3 mm was 2.23 × 106 cycles while it survived only 3.1 × 105 cycles when the connector was reduced to 3.5 × 2.5 mm. The angle of the oblique load has a significant effect on the stress distribution. 3-unit monolithic FPDs made of ZC have superior fatigue performance compared to those made of LD. The fatigue life of the zirconia FPD was about three times longer than that made of LD with a connector size of 4 mm × 3 mm. The survival rates of ZC FPDs are comparable to porcelain-fused-to-metal. A significant reduction in fatigue strength is predicted for reduced connector size. Therefore, it is necessary to establish general guidelines for the minimum connector size.

Surface roughness and marginal adaptation of stereolithography versus digital light processing three-dimensional printed resins: An in-vitro study.

The aim of this study was to assess surface roughness and marginal adaptation of Stereolithographic versus Digital Light Processed three-dimensional (3D) printed provisional resins. A 3-unit fixed partial denture (FPD) preparation was done on ideal model irrespective to 44-46. The Model was scanned and a 3-unit FPD was designed using 3-shape software. The STL file was transferred to two different 3D printers - Sprintray digital light processing (DLP) and Formlabs stereolithography (SLA). Eight samples were printed per group (total of 16 samples) using C and B temporary tooth-colored resin and cured according to the manufacturer's instructions. Marginal adaptation was checked for six surfaces per tooth for all the samples using a stereomicroscope. Surface roughness was also calculated for four samples from each group before and after polishing (pumice slurry + rouge and cotton buff) using a contact profilometer. The mean maximum marginal gap overall, was seen for the DLP group on the mesiobuccal surface of the first premolar, i.e., 178.8 ± 8.35 μm, while the minimal marginal gap was seen for the SLA group on the mesiolingual surface of first molar - 32.5 ± 7.07 μm. Furthermore, all the DLP samples showed a statistically significant higher mean marginal gap as compared to SLA samples (P < 0.005). All the samples showed surface roughness within the acceptable range. There was a statistically significant difference noted in Rz (roughness depth) before and after polishing (P < 0.05). 3D printed temporary resin FPD via SLA showed a much better marginal adaptation (49.6 μm mean marginal gap for 46 and 106.8 μm for 44) as compared to those printed via DLP (101.8 μm mean marginal gap for 46 and 157.5 μm for 44). All the samples showed an acceptable surface roughness. 3D printed temporaries have shown good marginal fit and adaptation and are a viable choice in patients where temporaries has to be given for long term before a final prosthesis can be fabricated (especially for full mouth rehabilitations).

Effect of Digital Technologies on the Marginal Accuracy of Conventional and Cantilever Co–Cr Posterior-Fixed Partial Dentures Frameworks

The introduction of new digital technologies represents an important advance to fabricate metal–ceramic restorations. However, few studies have evaluated the influence of these technologies on the fit of the restorations. The aim of this study was to evaluate the effect of different manufacturing techniques and pontic design on the vertical marginal fit of cobalt–-chromium (Co–Cr) posterior fixed partial dentures (FPDs) frameworks. Methods: Eighty stainless-steel dies were prepared to receive 3-unit FPDs frameworks with intermediate pontic (n = 40) and cantilever pontic (n = 40). Within each design, the specimens were randomly divided into four groups (n = 10 each) depending on the manufacturing technique: casting (CM), direct metal laser sintering (LS), soft metal milling (SM), and hard metal milling (HM). The frameworks were luted, and the vertical marginal discrepancy was assessed. Data analysis was made using Kruskal–Wallis and Mann–Whitney U tests (α = 0.05). Results: The vertical marginal discrepancy values of all FPDs were below 50 μm. The HM frameworks obtained the lowest misfit values in both designs. However, no differences were found among intermediate pontic groups or cantilevered groups. Likewise, when differences in a marginal discrepancy between both framework designs were analyzed, no differences were observed. Conclusions: The analyzed digital technologies demonstrated high precision of fit on Co–Cr frameworks and on both pontic designs.

Clinical behavior of posterior fixed partial dentures with a biologically oriented preparation technique: A 5-year randomized controlled clinical trial

Statement of problemEvidence of the behavior of the periodontal tissues around anterior teeth restored with the biologically oriented preparation technique (BOPT) is available. However, outcomes of this technique in posterior teeth restored with fixed partial dentures (FPDs) are lacking. PurposeThe purpose of this randomized controlled clinical trial was to evaluate the clinical, mechanical, and biological behavior of posterior 3-unit FPDs placed on teeth prepared with BOPT. Material and methodsForty participants received a 3-unit zirconia FPD in the posterior region of the mandible or maxilla. Twenty FPDs were placed on teeth prepared with BOPT (study group) and 20 on teeth with a horizontal chamfer finishing line (control group). Follow-up examinations were performed 1, 3, and 5 years after treatment to evaluate periodontal responses around the prepared teeth by means of the following parameters: plaque index, gingival index, probing depth, and marginal stability (MS). Mechanical behavior was also assessed, as were any complications. ResultsAfter the 5-year follow-up, 57.9% of the control group and 35% of the BOPT group presented a plaque index of 1. The gingival index was 1 in 68.4% of the control group and 30% of the BOPT group after the follow-up period. In the analysis of probing depth, 26.3% of teeth in the control group had pockets of more than 3 mm in depth, whereas the BOPT group had only 10%. Marginal stability appeared in 100% of the BOPT group, whereas only 10.5% of the control group exhibited gingival stability. Complications during the follow-up period were similar, 20% in the control group and 15% in the BOPT group. ConclusionsPosterior FPDs prepared by using BOPT had a good clinical response over a 5-year follow-up, with a low gingival index, a small increase in pocket depth, and a 100% marginal stability of the surrounding tissues. High survival rates after 5 years indicated that the technique produced predictable outcomes.

Dimensional precision of implant-supported frameworks fabricated by 3D printing

Statement of problemSelective laser melting (SLM) is a promising additive technology for clinical practice, but data on dimensional precision assessed by marginal fit combined with stress and strain investigations of implant-supported fixed partial dentures (FPDs) are lacking. PurposeThe purpose of this in vitro study was to verify whether the SLM additive manufacturing technology provides better dimensional precision for 3-unit FPD frameworks than subtractive manufacturing with soft metal block (SMB) milling and the standard casting technique. Material and methodsThirty 3-unit implant-supported FPDs with Co-Cr frameworks were made by the casting, SMB milling, and SLM methods (n=10). The marginal fit between the framework and the implant abutment was evaluated with photoelastic (PH) and strain gauge (SG) models. Stress and strain in the implant-supported system were measured by quantitative PH and SG analyses after prosthetic screw tightening. Data were subjected to the Kruskal-Wallis test, Mann-Whitney U test, and Spearman correlation test (α=.05). ResultsThe framework manufacturing method affected the marginal fit (P<.001), stress, and strain values (P<.05). The SLM group showed the best mean ±standard deviation marginal fit (μm) (PH model: 8.4 ±3.2; SG model: 6.9 ±2.1) in comparison with SMB milling (PH model: 42.3 ±15.7; SG model: 41.3 ±15.3) and casting (PH model: 43.5 ±27.8; SG model: 41.3 ±24.6) (P<.05). SLM showed lower mean ±standard deviation stress and strain values (60.3 ±11.6 MPa; 91.4 ±11.1 μstrain) than casting (225.5 ±142.8 MPa; 226.95 ±55.4 μstrain) and SMB milling (218.6 ±101.7 MPa; 289.7 ±89.3 μstrain) (P<.05). A positive correlation was observed between fit and stress or strain for all groups (P<.05). ConclusionsThree-unit FPD frameworks made using the SLM technology showed better dimensional precision than those obtained with the casting or SMB milling methods.

Effect of Thermomechanical and Static Loading on the Load to Fracture of Metal-Ceramic, Monolithic, and Veneered Zirconia Posterior Fixed Partial Dentures.

To evaluate the influence of static (not preloaded) and thermomechanical loading on the load to fracture of metal-ceramic, monolithic and veneered zirconia computer-aided design/computer-aided manufacturing (CAD/CAM) posterior fixed partial dentures (FPDs). One hundred standardized specimens with 2 abutments screwed onto a platform were prepared from stainless steel to receive a posterior 3-unit FPD with an intermediate pontic. Specimens were randomly divided into 5 groups (n = 20): Metal-ceramic (control group), Lava Zirconia system, Vita In-Ceram YZ, IPS e.max ZirCAD, and Lava Plus. Half of the specimens of each group (n = 10) underwent no preloading, and the other half were subjected to thermomechanical loading in a masticatory simulator, and then all FPDs were loaded until fracture using a universal testing machine at a 1 mm/min crosshead speed. The load to fracture of the veneering ceramic and the load to fracture of framework (total fracture) were recorded for each specimen. Data were statistically analyzed using 2-way ANOVA, Tukey's HSD post-hoc test, Student's t test, and Weibull statistics, α = 0.05. Significant differences were recorded between the metal-ceramic and veneered zirconia groups for the veneering ceramic load (p < 0.001; f = 36.62; f = 57.76) in no preloading and thermomechanical loading subgroups, respectively, but no differences were observed between the static and thermomechanical loading conditions. No differences were observed among the veneered zirconia groups. For the total load to fracture, significant differences were observed according to the material (p < 0.001; f = 500.8), between the metal-ceramic and Lava Plus group and the other zirconia groups in no preloading subgroup, and between metal-ceramic and the other groups (p < 0.001; f = 303.33) in thermomechanical loading subgroup. For the type of preloading, significant differences were observed (p = 0.02; f = 5.24) between the Lava Plus group and the other groups. Thermomechanical loading significantly decreased the fracture load of the Lava Plus group (p = 0.005). The Weibull statistics corroborated the results. Monolithic zirconia restorations provided the highest load to fracture values among the zirconia groups tested; however, the results indicate that they must be used in the oral environment with caution, because their load to fracture was influenced by the aging simulation.

Randomized controlled clinical trial of digital and conventional workflows for the fabrication of zirconia-ceramic posterior fixed partial dentures. Part II: Time efficiency of CAD-CAM versus conventional laboratory procedures

Statement of problemClinical trials are needed to evaluate the digital and conventional fabrication technology for providing fixed partial dentures (FPDs). PurposeThe purpose of the second part of this clinical study was to compare the laboratory production time for tooth-supported, 3-unit FPDs by means of computer-aided design and computer-aided manufacturing (CAD-CAM) systems and a conventional workflow. In addition, the quality of the 3-unit framework of each treatment group was evaluated clinically. Material and methodsFor each of 10 participants, a 3-unit FPD was fabricated. Zirconia was used as the framework material in the CAD-CAM systems and included Lava C.O.S. CAD software (3M) and centralized CAM (group L); CARES CAD software (Institut Straumann AG) and centralized CAM (group iT); and CEREC Connect CAD software (Dentsply Sirona) and centralized CAM (group C). The noble metal framework in the conventional workflow (group K) was fabricated by means of the traditional lost-wax technique. All frameworks were evaluated clinically before veneering. The time for the fabrication of the cast, the 3-unit framework, and the veneering process was recorded. In addition, chairside time during the clinical appointment for the evaluation of the framework was recorded. The paired Wilcoxon test together with appropriate Bonferroni correction was applied to detect differences among treatment groups (α=.05). ResultsThe total effective working time (mean ±standard deviation) for the dental technician was 220 ±29 minutes in group L, 217 ±23 minutes in group iT, 262 ±22 minutes in group C, and 370 ±34 minutes in group K. The dental technician spent significantly more time in the conventional workflow than in the digital workflow, independent of the CAD-CAM systems used (P<.001). ConclusionsIrrespective of the CAD-CAM system, the overall laboratory time for the dental technician was significantly less for a digital workflow than for the conventional workflow.

Mechanical properties of cobalt-chromium 3-unit fixed dental prostheses fabricated by casting, milling, and additive manufacturing

Statement of problemNew additive manufacturing techniques for nonprecious alloys have made the fabrication of metal-ceramic fixed partial dentures (FPDs) less expensive and less time-consuming. However, whether the mechanical properties produced by these techniques are comparable is unclear. PurposeThe purpose of this in vitro study was to evaluate the mechanical properties of cobalt-chromium frameworks for FPDs fabricated by 3 different techniques. Material and methodsThirty frameworks for 3-unit FPDs were fabricated by traditional casting, computer-aided design and computer-aided manufacturing (CAD-CAM) milling, and selective laser melting (SLM), with n=10 in each group. The frameworks were weighed, and distal and mesial connector areas measured. The frameworks were cemented and loaded centrally (0.5 mm/s) until deformation above 1 mm occurred. Stiffness was measured as the slope of the axis between 500 and 2000 N. Microhardness was measured on sectioned specimens by Vickers indentation. The microstructure was also analyzed by scanning electron microscopy. One-way ANOVA with Tukey post hoc analysis was used to compare the groups (α=.05). ResultsThe framework design differed among the groups, making a comparison of strength impossible. The milled frameworks appeared bulky, while the cast and SLM frameworks were more slender. Statistically significant differences were found in microhardness, stiffness, wall thickness, weight, and connector size (P<.05), and a significant correlation was found between hardness and stiffness (–0.4, P<.005). ConclusionsFabrication method affects the design, stiffness, microhardness, and microstructure of cobalt-chromium FPD frameworks. The SLM frameworks were stiffer and harder than the cast and milled specimens.

Influence of repeated firings on marginal, axial, axio-occlusal, and occlusal fit of metal-ceramic restorations fabricated with different techniques

Statement of problemIll-fitting restorations can jeopardize dental, periodontal, and systemic health. Repeated ceramic firing may influence the fitting accuracy of restorations, but scientific information regarding this issue is lacking. PurposeThe purpose of this in vitro study was to assess and compare the influence of repeated firings on the marginal, axial, axio-occlusal, and occlusal fit of metal-ceramic 3-unit fixed partial dentures (FPDs) manufactured with different framework methods, including casting, fully sintered hard alloy milling (FHAM), presintered soft alloy milling (PSAM), and selective laser sintering (SLS). Material and methodsA total of 60 Co-Cr metal frameworks for 3-unit FPDs were fabricated with 3 different computer-aided design and computer-aided manufacturing (CAD-CAM) techniques and conventional casting for a typodont model. The discrepancy values for premolar and molar abutments were measured by using the silicone replica technique after fabrication of the framework, second firing, fourth firing, and seventh firing. The replicas were separated into mesiodistal and buccolingual cross-sections, and digital images of the cross-sections were obtained with a stereomicroscope at ×80 magnification. The measurement points were examined to record the discrepancy values (μm) with in-built measuring software. The recorded data were subjected to repeated-measures 4-way ANOVA and the Bonferroni post hoc test (α=.05). ResultsFor all measurement periods, the marginal, axial, axio-occlusal, and occlusal discrepancy values differed significantly among the manufacturing groups (P<.001). Moreover, the repeated firings had a statistically significant influence on the discrepancy values of PSAM, FHAM, and SLS groups (P<.05). The cast group was not significantly affected by repeated firings (P>.05). The PSAM group revealed the lowest discrepancy values at all measurement periods (P<.05), except after the second firing in the marginal and axial locations. ConclusionsThe PSAM-fabricated restorations demonstrated superior fitting accuracy. All manufacturing groups were influenced by repeated firings, except the cast group. The marginal discrepancy values of all manufacturing groups were within the range of clinical acceptability (<120 μm).

Fatigue resistance of all-ceramic fixed partial dentures – Fatigue tests and finite element analysis

ObjectiveTo estimate the fatigue resistance of a new translucent zirconia material in comparison to lithium disilicate for 3-unit fixed partial dentures (FPDs). MethodsEighteen 3-unit FPDs (replacement of first upper molar) with a connector size of 4mm×4mm were dry milled with a five-axis milling machine (Zenotec Select, Wieland, Germany) using discs made of a new translucent zirconia material (IPS e.max ZirCAD MT, Ivoclar Vivadent). Another 9 FPDs with a reduced connector size (3mm×4mm) were milled. The zirconia FPDs were sintered at 1500°C. For a comparison, 9 FPDs were made of IPS e.max Press, using the same dimensions. These IPS e.max Press FPDs were ground from a wax disc (Wieland), invested and pressed at 920°C. All FPDs were glazed twice. The FPDs were adhesively luted to PMMA dies with Multilink Automix. Dynamic cyclic loading was carried out on the molar pontic using Dyna-Mess testing machines (Stolberg, Germany) with 2×106 cycles at 2Hz in water (37°C). Two specimens per group and load were subjected to decreasing load levels (at least 4) until the two specimens no longer showed any failures. Another third specimen was subjected to this load to confirm the result. All the specimens were evaluated under a stereo microscope (20× magnification). The number of cycles reached before observing a failure, and their dependence on the load and on the material, were modeled, using a Weibull model. This made it possible to estimate the fatigue resistance as the maximum load for which one would observe less than 1% failure after 2×106 cycles. In addition to the experimental study, Finite Element Modeling (FEM) simulations were conducted to predict the force to failure for IPS e.max ZirCAD MT and IPS e.max Press with a reduced cross-section of the connectors. ResultsThe failure mode of the zirconia FPDs was mostly the fracture of the distal connector, whereas the failure mode of the lithium disilicate FPDs observed to be the fracture of the connectors or multiple cracks of the pontic. The fatigue resistance with 1% fracture probability was estimated to be 488N for the IPS e.max ZirCAD MT FPDs (453N for repeated test), 365N for IPS e.max ZirCAD MT FPDs with reduced connector size and 286N for the e.max Press FPDs. All three IPS e.max ZirCAD groups statistically performed significantly better than IPS e.max Press (p<0.001). On the other hand, no significant difference could be established between the two IPS e.max ZirCAD MT3 groups with a 4mm×4mm connector size (p>0.05). The allowable maximum principal stress (σmax) which did not lead to failure during fatigue testing for IPS e.max ZirCAD MT3 was calculated between 208MPa and 223MPa for FPDs with 4mm×4mm connectors for 2×106 cycles. This value could also be verified for the FPDs of the same material with 3mm×4mm connectors. On the other hand fatigue strength in terms of σmax at 2×106 cycles of IPS e.max Press was calculated to be between 78 and 90MPa. SignificanceThe fatigue resistance of the translucent zirconia 3-unit FPDs was about 60–70% higher than that of the lithium disilicate 3-unit FPDs, which may justify their use for molar replacements, provided that a minimal connector size of 4mm×4mm is observed. Even with a limited number of specimens (n=9) per group it was possible to statistically differentiate between the tested groups.

In vitro Evaluation of the Accuracy of Seating Cast Metal Fixed Partial Denture on the Abutment Teeth with Varying Degree of Convergence Angle.

The prime goal of a diligent prosthodontist is to obtain adequate marginal fit while restoring lost tooth structure. The marginal fit of the restoration, in turn depends upon the geometrical morphology of the tooth preparation. To determine the effect of varying degree of convergence angle on the marginal seating of the single crown, three-unit fixed partial denture and multiple-unit fixed partial denture with pier abutment. Three dies, of same convergence angle, were placed in an arch form on a base. In this way, four arch forms were prepared for four different convergence angles i.e. 0°, 6°, 12°, and 20°. Five castings each were made for single crown, 3-unit fixed partial denture and multiple-unit fixed partial denture (FPD) with pier abutment for each convergence angle. The castings were seated on their respective dies and vertical marginal discrepancy was measured at four points for each casting with the help of an optical microscope. The results showed that 200 convergence angle showed better marginal seating of the single crown, 3-unit FPD as well as for the multiple unit FPD. There was a possibility that the retention and resistance may be compromised with 200 taper. Hence 120 taper is suggested for crowns and fixed partial denture retainers as the marginal discrepancy is reasonable and retention and resistance is optimum. There was a high statistical significant difference in the values obtained for the different convergence angles.

In Vitro Comparison of Marginal and Internal Fit of Press-on-Metal Ceramic (PoM) Restorations with Zirconium-Supported and Conventional Metal Ceramic Fixed Partial Dentures Before and After Veneering.

To compare marginal and internal fit between 3- and 4-unit press-on-metal (PoM) ceramic, zirconia-supported, and conventional metal ceramic fixed partial dentures (FPDs) before and after veneering. Ten pieces for each 3- and 4-unit MC, IPS InLine PoM, and IPS e.max ZirCAD/Zir Press FPDs were produced. Cross-sections from silicone replicas were examined and measured with a light microscope. Occlusal, axial, intermarginal, and marginal mean adaptation scores of cross-sectioned replicas and means of measurements obtained from 4 sites were calculated independently. Mean values for molars were 78.44 ± 32.01 μm (MC), 89.84 ± 29.20 μm (PoM), and 85.17 ± 28.49 μm (Zir). Premolar values were 76.08 ± 27.92 μm (MC), 89.94 ± 23.49 μm (PoM), and 87.18 ± 28.25 μm (Zir). No difference existed between the means of 3- and 4-unit FPDs except the molar-intermarginal region. The mean value of 4-unit FPDs (93.88 ± 25.41 μm) was less than the 3-unit FPDs (103.68 ± 24.55 μm) at the molar-inter marginal region. A gap increase was observed in all sites except the molar-axio-occlusal region after veneering. According to the mean difference, gap increases at the molar-marginal, molar-intermarginal, and premolar-intermarginal regions were statistically significant. A statistical difference was found at the molar-marginal region for 4-unit MCR (p = 0.041) and 4-unit PoM FPDs (p = 0.042) before and after veneering. Gap increase after veneering of 4-unit metal ceramics at molar-intermarginal, premolar-marginal, and premolar-intermarginal regions (p = 0.020; p = 0.015; p = 0.004) was significant. The gap measurements of the IPS InLine PoM and IPS e.max ZirCAD/Zir Press groups were all clinically acceptable. No studies on marginal and internal fit in the IPS InLine PoM system have been published to date. This study should be supported with future studies. No significant increase was observed after press-veneering the IPS e.max ZirCAD frameworks with an IPS e.max ZirPress material; therefore, we recommend the use of this combination.

치과 캐드/캠 시스템으로 제작된 지르코니아 single 코핑과 3-unit 구조물의 상대적 적합도 비교

Purpose: The purpose of this study was to assess the marginal and mesial fitness of zirconia single copings and 3-unit fixed partial dentures (FPDs) manufactured with an identical model. Materials and Methods: An epoxy model in which the maxillary right 2nd premolar is lost and maxillary 1st premolar and 2nd molar are formed as abutments was manufactured and scanned by using a laser scanner. A ten units of zirconia single copings were manufactured for maxillary 1st premolar and 2nd molar, respectively and the same number of 3-unit FPDs were manufactured. For the measurements of fitness, the manufactured silicone replicas were divided into four parts and the fitness were measured by digital microscope at measurement points (P1, P2, P3, P4 and P5) of each plane. The measured gaps were classified into three categories: marginal gap (MG, P1), axial gap (AG, average of P2 and P3), occlusal gap (OG, average of P4 and P5). Results: The ranges of MG, AG and OG for single copings were 18.47 - 40.54 µm, 39.73 - 73.61 µm and 116.90 - 134.69 µm, respectively. The ranges of MG, AG and OG for 3-unit FPDs were 45.95 - 87.44 µm, 23.78 - 57.00 µm and 99.89 - 131.06 µm, respectively. Conclusion: The result of the study shows that the MGs for 3-unit FPDs were higher than those of single copings, though they are within the range of clinical acceptance, indicating that the use of more homogeneous zirconia block and modification of sintering processes are needed to ensure the prevention of increase of gap in 3-unit FPDs. (J Dent Rehabil Appl Sci 2014;30(1):16-22)