• The Journal of Advanced Prosthodontics
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• v.13 no.5
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• pp.281-291
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• 2021

PURPOSE. To evaluate the wear of computer-aided design/computer-aided manufacturing (CAD-CAM) dental ceramic materials opposed by enamel as a function of increased chewing forces. MATERIALS AND METHODS. The enamel cusps of healthy human third molar teeth (n = 40) opposed by materials from CAD-CAM dental ceramic groups (n = 10), including Vita Enamic^® (ENA), a polymer-infiltrated ceramic network (PICN); GC Cerasmart^® (CERA), a resin nanoceramic; Celtra^® Duo (DUO), a zirconia-reinforced lithium silicate (ZLS) ceramic; and IPS e.max ZirCAD (ZIR), a polycrystalline zirconia, were exposed to chewing simulation (1,200,000 cycles; 120 N load; 1 Hz frequency; 0.7 mm lateral and 2 mm vertical motion). The wear of both enamel cusps and materials was quantified using a 3D laser scanner, and the wear mechanisms were evaluated by scanning electron microscopy (SEM). The results were analysed using Welch ANOVA and Kruskal Wallis test (α = .05). RESULTS. ZIR showed lower volume loss (0.02 ± 0.01 mm³) than ENA, CERA and DUO (P = .001, P = .018 and P = .005, respectively). The wear of cusp/DUO [0.59 mm³ (0.50-1.63 mm³)] was higher than cusp/CERA [0.17 mm³ (0.04-0.41 mm³)] (P = .007). ZIR showed completely different wear mechanism in SEM. CONCLUSION. Composite structured materials such as PICN and ZLS ceramic exhibit more abrasive effect on opposing enamel due to their loss against wear, compared to uniform structured zirconia. The resin nano-ceramic causes the lowest enamel wear thanks to its flexible nano-ceramic microstructure. While zirconia appears to be an enamel-friendly material in wear volume loss, it can cause microstructural defects of enamel.

• The Journal of Korean Academy of Prosthodontics
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• v.58 no.3
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• pp.217-220
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• 2020

Conventionally, when a zirconia fixed dental restoration is planned, the interim restoration is made manually and the final restoration is fabricated by the silicone impression taking at the prosthodontic stage. This conventional workflow does not provide direct relation between interim and final restorations. Moreover, the predictability of the final restoration could be low. Nowadays, the CAD/CAM based restoration fabrication and related digital techniques are developed and being applied in dentistry in multiple ways. This case report introduces a digital workflow for fabricating an optimal gingival adaptation and predictability of monolithic zirconia restoration by using CAD/CAM interim restoration, intra oral scan, and image superimposition technique in a case that required tooth extraction.

• Journal of Korean society of Dental Hygiene
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• v.22 no.6
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• pp.467-475
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• 2022

Objectives: This study aimed to understand the definitions, types, and principles of computer-aided design/computer-aided manufacturing (CAD/CAM) and scanners due to the introduction of digital workflows. Methods: This study was based on information from the government's law and articles published in academic journals. Results: CAD/CAM is a technology that measures the shape three-dimensionally, saves it as data, designs it into the desired shape, and processes the product. Scanners, which are classified as intraoral and extraoral scanners, measure teeth and the intraoral environment three-dimensionally and convert them into three-dimensional (3D). A 3D printer is a machine that creates a 3D object by layering materials based on a 3D drawing. It can be classified into four types according to the method: extrusion, powder bonding, lamination, and photopolymerization methods. The most used 3D printer methods in dentistry are stereolithograhpy and digital light processing, and they are widely used in prosthetic, surgical, and orthodontic fields. Conclusions: As the dental system is digitized, it is expected that the government will classify the dental hygienist scope of work and the universities will reflect the curriculum; it is necessary to develop excellent dental hygienists, diversify the educational pathways, and establish policies to meet the needs of the increasing number of patients.

• Journal of Technologic Dentistry
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• v.45 no.2
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• pp.31-38
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• 2023

Purpose: This in vitro study aimed to compare the trueness of 3-unit fixed dental provisional prostheses (FDPs) fabricated by three different additive manufacturing and subtractive manufacturing procedures. Methods: A reference model with a maxillary left second premolar and the second molar prepped and the first molar missing was scanned for the fabrication of 3-unit FDPs. An anatomically shaped 3-unit FDP was designed on computer-aided design software. 10 FDPs were fabricated by subtractive (MI group) and additive manufacturing (stereolithography: SL group, digital light processing: DL group, liquid crystal displays: LC group) methods, respectively (N=40). All FDPs were scanned and exported to the standard triangulated language file. A three-dimensional analysis program measured the discrepancy of the internal, margin, and pontic base area. As for the comparison among manufacturing procedures, the Kruskal-Wallis test and the Mann-Whitney test with Bonferroni correction were evaluated statistically. Results: Regarding the internal area, the root mean square (RMS) value of the 3-unit FDPs was the lowest in the MI group (31.79±6.39 ㎛) and the highest in the SL group (69.34±29.88 ㎛; p=0.001). In the marginal area, those of the 3-unit FDPs were the lowest in the LC group (25.39±4.36 ㎛) and the highest in the SL group (48.94±18.98 ㎛; p=0.001). In the pontic base area, those of the 3-unit FDPs were the lowest in the LC group (8.72±2.74 ㎛) and the highest in the DL group (20.75±2.03 ㎛; p=0.001). Conclusion: A statistically significant difference was observed in the RMS mean values of all the groups. However, in comparison to the subtractive manufacturing method, all measurement areas of 3-unit FDPs fabricated by three different additive manufacturing methods are within a clinically acceptable range.

• Restorative Dentistry and Endodontics
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• v.43 no.3
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• pp.27.1-27.9
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• 2018

Objectives: The aim of this in vitro study was to evaluate the effects of the thickness and shade of 3 types of computer-aided design/computer-aided manufacturing (CAD/CAM) materials. Materials and Methods: A total of 120 specimens of 2 shades (A1 and A3) and 2 thicknesses (1 and 2 mm) were fabricated using VITA Mark II (VM; VITA Zahnfabrik), IPS e.max CAD (IE; IvoclarVivadent), and VITA Suprinity (VS; VITA Zahnfabrik) (n = 10 per subgroup). The amount of light transmission through the ceramic specimens was measured by a radiometer (Optilux, Kerr). Light-cured resin cement samples (Choice 2, Bisco) were fabricated in a Teflon mold and activated through the various ceramics with different shades and thicknesses using an LED unit (Bluephase, IvoclarVivadent). In the control group, the resin cement sample was directly light-cured without any ceramic. Vickers microhardness indentations were made on the resin surfaces (KoopaPazhoohesh) after 24 hours of dark storage in a $37^{\circ}C$ incubator. Data were analyzed using analysis of variance followed by the Tukey post hoc test (${\alpha}=0.05$). Results: Ceramic thickness and shade had significant effects on light transmission and the microhardness of all specimens (p < 0.05). The mean values of light transmittance and microhardness of the resin cement in the VM group were significantly higher than those observed in the IE and VS groups. The lowest microhardness was observed in the VS group, due to the lowest level of light transmission (p < 0.05). Conclusion: Greater thickness and darker shades of the 3 types of CAD/CAM ceramics significantly decreased the microhardness of the underlying resin cement.

• The Journal of Korean Academy of Prosthodontics
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• v.57 no.3
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• pp.288-295
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• 2019

Passive fit of prosthesis is an essential property of implant supported prosthesis for long term success and minimization of complications. And the property is determined mostly by fabrication procedure. There were limitations of extensive implant prosthesis because conventional casting method generate contraction error of long span prosthesis. However, Computer-aided design/Computer-aided manufacturing (CAD/CAM) technology of 3D printing and milling metal framework can overcome those limitations. This case is a full mouth rehabilitation using extensive implant fixed prosthesis. Removable interim prosthesis was made for esthetic, functional evaluation and a guide for implant insertion. After the insertion, implant fixed interim prosthesis was delivered. After additional evaluation and adjustment, final prosthesis was designed with CAD, the fabricated with CAM. Milling technique was used for anterior screw type implant superstructure and 3D printing technique was used for the anterior and posterior implant copings. Fit of the final restoration was favorable. The practitioner and patient were both esthetically and functionally satisfied with the final result.

• Restorative Dentistry and Endodontics
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• v.44 no.3
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• pp.27.1-27.12
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• 2019

This case report describes a technique in which endodontic treatment and permanent indirect restoration were completed in the same clinical appointment with the aid of a computer-aided design/computer-aided manufacturing (CAD/CAM) system. Two patients were diagnosed with irreversible pulpitis of the mandibular first molar. After access preparation, root canals were located, irrigation was performed until bleeding ceased, and the coronal tooth structure was prepared for indirect restoration. Then, utilizing an interim 3-mm build-up of the endodontic access cavity, a hemi-arch digital scan was performed with an intraoral scanner. Subsequent to digital scanning, restoration design was performed simultaneously with the endodontic procedure. The root canals were shaped using the Race system under irrigation with 2.5% sodium hypochlorite followed by root canal filling. The pulp chamber was subsequently filled with a 3-mm-thick composite resin restoration mimicking the interim build-up previously utilized to facilitate block milling in the CAD/CAM system. Clinical try-in of the permanent onlay restoration was followed by acid etching, application of a 5th generation adhesive, and cementation of the indirect restoration. Once the restoration was cemented, rubber dam isolation was removed, followed by occlusal adjustment and polishing. After 2 years of follow-up, the restorations were esthetically and functionally satisfactory, without complications.

• The Journal of Korean Academy of Prosthodontics
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• v.47 no.1
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• pp.53-60
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• 2009

Statement of problem: At present, as the esthetic demands are on the increase, there are many ongoing studies for tooth-colored post and cores. Most of them are about fiber post and prefabricated zirconia post, but few about one-piece milled zirconia post and core using CAD/CAM (computer-aided design/computer-aided manufacturing) technique. Purpose: The objective of this study was to compare microleakage of endodontically treated teeth restored with three different tooth-colored post and cores. Material and methods: Extracted 27 human maxillary incisors were cut at the cementoenamel junction, and the teeth were endodontically treated. Teeth were divided into 3 groups (n=9); restored with fiber post and resin core, prefabricated zirconia post and heat-pressed ceramic core, and CAD/CAM milled zirconia post and core. After the preparation of post space, each post was cemented with dual-polymerized resin cement (Variolink II). Teeth were thermocycled for 1000 cycles between $5-55^{\circ}C$ and dyed in 2% methylene blue at $37^{\circ}C$ for 24 hours. Teeth were sectioned (bucco-lingual), kept the record of microleakage and then image-analyzed using a microscope and computer program. The data were analyzed by one-way ANOVA and Scheffe's multiple range test (${\alpha}=0.05$). Results: All groups showed microleakage and there were no significant differences among the groups (P>.05). Prefabricated zirconia post and heat-pressed ceramic core showed more leakage in dye penetration at the post-tooth margin, but there was little microleakage at the end of the post. Fiber post and resin core group and CAD/CAM milled zirconia post and core group indicated similar microleakage score in each stage. Conclusion: Prefabricated zirconia post and heat-pressed ceramic core group demonstrated better resistance to leakage, and fiber post and resin core group and CAD/CAM milled zirconia post and core group showed the similar patterns. The ANOVA test didn't indicate significant differences in microleakage among test groups. (P>.05)

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.13 no.2
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• pp.95-98
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• 2017

Due to hypodontia, poor oral hygiene, and significantly more prevalent periodontal disease, patients with Down syndrome show higher incidence of edentulism. Oral rehabilitation of such patients is imperative but challenging as high rates of prosthesis failure are reported due to malocclusion, high masticatory force, and parafunctional habits. As CAD/CAM(Computer-Aided Design and Computer Aided Manufacturing) is the recent trend in prosthodontics, this report discusses the application of CAD/CAM in a Down syndrome patient. A 25-year-old patient with Down syndrome was presented to the Department of Pediatric Dentistry, Yonsei University Dental Hospital for oral examination. 5 maxillary teeth were missing, 3 were fully impacted, and 4 had grade III mobility. The patient underwent general anesthesia for extraction of impacted and mobile teeth, implant surgery, and final impression for prosthesis. Afterwards, CAD/CAM was used to design and manufacture a 10-unit zirconia bridge. However the bridge was fractured after 18 months due to the patient's bruxism and high masticatory force. Final impression taking, bite registration, cast fabrication, cast scanning, and prosthesis designing were not needed as CAD/CAM data remained. Previous CAD/CAM design was used to remanufacture the zirconia bridge. Down syndrome patients have malocclusion, high masticatory force, and parafunctional habits which increase the possibility of prosthesis fracture. CAD/CAM is beneficial for Down syndrome patients as previous digital records can be utilized for prosthesis repair or remake. In detail, application of CAD/CAM in remanufacturing decreases patient's discomfort of impression taking, shortens and simplifies dental laboratory procedures, and reduces clinician's effort of taking detailed final impressions or accurate bite registration. In conclusion, oral rehabilitation using CAD/CAM provides not only satisfactory levels of comfort, stability, and esthetics, but also easier repair or remake compared to conventional prostheses.

• The Journal of Korean Academy of Prosthodontics
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• v.59 no.1
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• pp.97-106
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• 2021

Dental implants should be placed at ideal sites for implant-supported restorations. For a patient with insufficient residual ridge, mouth preparation including surgical intervention can be indicated to establish a soft and hard tissue environment favorable for a definitive prosthesis. Prosthodontic design based on computer-guided surgery and computer-aided design-computer-aided manufacturing (CAD-CAM) provides a visual blueprint allowing a clinician to assess the necessity of such a surgical intervention beforehand. In this case, a definitive restoration was planned and made via a CAD-CAM system according to the patient's oral status before treatment, simulated surgical interventions and serial provisional restorations. Based on the planning, a guided template was made and the implants were installed with bone augmentation using the template. Customized abutments, the first and the second provisional restorations were designed and fabricated by CAD-CAM. The definitive restorations were digitally made following the shape of the second provisional prostheses, which were confirmed in the patient's mouth. The patient was satisfied with the masticatory, phonetic and aesthetic functions of these definitive prostheses.