Evaluation of marginal fidelity of copy-milled and CAD/CAM all ceramic crowns

Statement of the problem. The interest in all-ceramic restorations has increased as more techniques have become available. With the introduction of machinable dental ceramics and CAD/CAM systems or Copy-milling systems there is a need for evaluating the quality levels of these new fabrication techniques. Purpose. This study was to evaluate the fitting accuracy of machined all-ceramic crowns made out of an industrially prefabricated feldspathic porcelain. Material and Methods. Three master models with different cutting depth (0.8mm/1.0mm/1.2mm)were produced using a palladium-silver alloy. A total of 36 working dies, 12 of each form, was used for the modellation of prototype resin copings and 36 additional crowns, 12 of each cutting depth, were produced by using the $CEREC^{(R)}2$ system for all crowns. The maginal fit of all 72 crowns was then evaluated on their respective master die at 54 circularly staggered points of measurement per crown under a fixation pressure of 30 N by using a computerized video image system. Results. The medians of the copy-milled $CELAY^{(R)}$ crowns ranged from 29 to $36{\mu}m$. The highest value for the marginal gap was found in group B (cutting depth 1.0mm) at $107{\mu}m$. The median for the $CEREC^{(R)}2$ crowns was found between 43.5 and $70{\mu}m$. The maximum values for all three groups ranged from $181{\mu}m$ to $286{\mu}m$. With $286{\mu}m$ the highest value for marginal gap was found in group C. the Kruskal-Wallis test and multiple comparisons analysis procedure revealed a significant influence of the production technique on the marginal fit in all three groups (p<0,02). Conclusion. 1. The $CELAY^{(R)}$ system is capable to produce all-ceramic crowns with a significantly better marginal fit than the $CEREC^{(R)}2$ system. 2. As far as premolar crowns produced with the $CEREC^{(R)}2$ system are concerned, the cutting depth has a significant influence on fitting accuracy. 3. The production of crowns with an acceptable marginal fit is possible with both systems. However, adhesive luting is recommended for milled feldspathic porcelain crowns.